Chen Qiang, Li Yike, Yang Siqi, He Haoming, Xie Yingying, Wang Wei, Wang Long, Gao Yanxiang, Cai Lin, Xiong Shiqiang, Zheng Jingang
Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 100029 Beijing, China.
Department of Cardiology, China-Japan Friendship Hospital, 100029 Beijing, China.
Rev Cardiovasc Med. 2025 Jul 23;26(7):38389. doi: 10.31083/RCM38389. eCollection 2025 Jul.
Renal dysfunction is linked to both the complexity of coronary artery lesions and the prognosis of acute coronary syndrome (ACS). However, the nature of this intricate relationship remains unclear. Therefore, this study aimed to investigate the mechanisms through which coronary lesion complexity mediates the association between renal dysfunction and adverse cardiovascular outcomes in patients with ACS.
This analysis included 1400 ACS patients who underwent percutaneous coronary intervention (PCI). Renal function was assessed using the estimated glomerular filtration rate (eGFR), calculated according to the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, which incorporates both creatinine and cystatin C. Coronary lesion complexity was evaluated using the baseline SYNTAX score (bSS). The associations among eGFR, bSS, and major adverse cardiovascular events (MACEs) were examined using survival analysis, restricted cubic spline (RCS) analysis, and mediation analysis.
A total of 229 MACEs (16.4%) occurred over a median follow-up of 31.03 (27.34, 35.06) months, including 99 all-cause deaths (7.0%), 41 myocardial infarctions (2.9%), and 123 unplanned revascularizations (8.9%). After multivariate adjustment, both the eGFR and bSS significantly predicted MACEs across the total population and various subgroups. Mediation analysis showed that bSS mediated 16.49%, 14.76%, 12.87%, and 11.95% of the correlation between eGFR and MACEs in different adjusted models.
The relationship between renal dysfunction and MACEs in ACS patients is partially mediated by coronary lesion complexity. This finding underscores the importance of integrating kidney function assessments with coronary anatomical evaluations to develop individualized risk stratification strategies.
肾功能不全与冠状动脉病变的复杂性以及急性冠状动脉综合征（ACS）的预后均相关。然而，这种复杂关系的本质仍不清楚。因此，本研究旨在探讨冠状动脉病变复杂性介导ACS患者肾功能不全与不良心血管结局之间关联的机制。
本分析纳入了1400例接受经皮冠状动脉介入治疗（PCI）的ACS患者。使用根据2021年慢性肾脏病流行病学协作组（CKD-EPI）方程计算的估计肾小球滤过率（eGFR）评估肾功能，该方程纳入了肌酐和胱抑素C。使用基线SYNTAX评分（bSS）评估冠状动脉病变复杂性。采用生存分析、限制性立方样条（RCS）分析和中介分析研究eGFR、bSS与主要不良心血管事件（MACE）之间的关联。
在中位随访31.03（27.34，35.06）个月期间，共发生229例MACE（16.4%），包括99例全因死亡（7.0%）、41例心肌梗死（2.9%）和123例非计划血管重建（8.9%）。多变量调整后，eGFR和bSS在总体人群及各个亚组中均显著预测MACE。中介分析显示，在不同调整模型中，bSS介导了eGFR与MACE之间相关性的16.49%、14.76%、12.87%和11.95%。
ACS患者肾功能不全与MACE之间的关系部分由冠状动脉病变复杂性介导。这一发现强调了将肾功能评估与冠状动脉解剖评估相结合以制定个体化风险分层策略的重要性。
