PURPOSE: To investigate in patients undergoing coronary angiography for suspected coronary artery disease (CAD) the association of 3-vessel obstructive CAD with severe or moderate decrease of glomerular filtration rate (GFR).
METHODS: In a prospective study, 1007 patients had coronary angiography performed. The patients included 672 men and 335 women, mean age 66 ± 8 years. Obstructive CAD was diagnosed if the patient had >50% narrowing of at least 1 coronary artery. Glomerular filtration rate (GFR) was calculated prior to coronary angiography using the Modification of Diet in Renal Disease equation. Severe renal insufficiency (RI)was diagnosed if the GFR was <30 ml/min/1.73 m2. Moderate RI was diagnosed if the GFR was 30-59 ml/min/1.73 m2. Mild or no RI was diagnosed if the GFR was 60 ml/min/1.73 m2 or higher. Age, gender, race, smoking, hypertension, and hypercholesterolemia were similar in patients with moderate or severe decrease in GFR versus mild or no decrease in GFR. Diabetes was present in 112 of 259 patients (43%) with moderate or severe decrease in GFR versus 206 of 748 patients (28%) with no or mild decrease in GFR (p<0.001).
RESULTS: Obstructive CAD was present in 225 of 259 patients (87%) with moderate or severe decrease in GFR versus 533 of 748 patients (71%) with mild or no decrease in GFR (p<0.001). 3-vessel obstructive CAD was present in 138 of 259 patients (53%) with moderate or severe GFR decrease and in 170 of 748 patients (23%) with mild or no GFR decrease (p<0.001). Logistic regression analysis showed that patients with moderate or severe GFR decrease had a 4.1 times higher risk of developing 3-vessel CAD after controlling the effect of diabetes than patients with mild or no GFR decrease (relative risk = 4.1; 95% CI, 3.0, 5.5).
CONCLUSION: Moderate or severe reduction in GFR is a significant risk factor for obstructive CAD and for obstructive 3-vessel CAD.
CLINICAL IMPLICATIONS: Patients with moderate or severe reduction in GFR should have intensive modification of coronary risk factors.
DISCLOSURE: Omar Khalique, No Financial Disclosure Information; No Product/Research Disclosure Information