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Cosentino N, Trombara F, Marenzi G. Glomerular filtration rate estimation and all-cause and cardiovascular mortality risk prediction: a progressive refinement in accuracy. Eur J Prev Cardiol 2023; 30:1652-1653. [PMID: 37335946 DOI: 10.1093/eurjpc/zwad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Nicola Cosentino
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
| | - Filippo Trombara
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino, I.R.C.C.S., Via Parea 4, Milan 20138, Italy
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2
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Ram E, Peled Y, Karni E, Mazor Dray E, Cohen H, Raanani E, Sternik L. The predictive value of five glomerular filtration rate formulas for long‐term mortality in patients undergoing coronary artery bypass grafting. J Card Surg 2022; 37:2663-2670. [PMID: 35914027 PMCID: PMC9544701 DOI: 10.1111/jocs.16667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/11/2022] [Accepted: 05/07/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Eilon Ram
- Department of Cardiac Surgery Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
- The Sheba Talpiot Medical Leadership Program Ramat Gan Israel
| | - Yael Peled
- Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Ehud Karni
- Department of Cardiac Surgery Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Efrat Mazor Dray
- Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Hillit Cohen
- Department of Cardiac Surgery Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Ehud Raanani
- Department of Cardiac Surgery Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Leonid Sternik
- Department of Cardiac Surgery Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
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3
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Ram E, Beckerman P, Segev A, Shlomo N, Atlas-Lazar A, Sternik L, Raanani E. The predictive value of creatinine clearance for mortality in patients undergoing revascularization. J Cardiothorac Surg 2021; 16:120. [PMID: 33933109 PMCID: PMC8088555 DOI: 10.1186/s13019-021-01502-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background Renal function plays a significant role in the prognosis and management of patients with multi-vessel coronary artery disease (CAD) referred for revascularization. Current data lack precise risk stratification using estimated glomerular filtration rate (eGFR) and creatinine clearance. Methods This prospective study includes a three-year follow-up of 1112 consecutive patients with multi-vessel CAD enrolled in the 22 hospitals in Israel that perform coronary angiography. Results The Mayo formula yielded the highest mean eGFR (90 ± 26 mL/min per 1.73m2) and chronic kidney disease-epidemiology collaboration (CKD-EPI) the lowest (76 ± 24 mL/min per 1.73m2). Consequently, the Mayo formula classified more patients (56%) as having normal renal function. There was a significant and strong correlation between the values obtained from all five formulas using Cockcroft-Gault as the reference formula: Mayo: r = 0.80, p < 0.001; CKD-EPI: r = 0.87, p < 0.001; modification of diet in renal disease (MDRD): r = 0.84, p < 0.001; inulin clearance-based: r = 0.99, p < 0.001). Multivariable analysis demonstrated that decreased renal function is an independent predictor of 3-year mortality in all five formulas, with risk increasing by 15–25% for each 10-unit decrease in eGFR. Despite the similarities between the formulas, the ability to predict mortality was highest in the Mayo formula and lowest in MDRD. Conclusions Our data suggest that while the Mayo formula is not currently recommended by any nephrology guidelines, it may be an alternative formula to predict mortality among patients with multivessel CAD, including to the widely used MDRD formula. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01502-1.
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Affiliation(s)
- Eilon Ram
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel. .,Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Pazit Beckerman
- Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nephrology, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel
| | - Amit Segev
- Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel
| | - Nir Shlomo
- Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel
| | | | - Leonid Sternik
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel.,Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, 52621, Tel Hashomer, Israel.,Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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4
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Kanic V, Ekart R, Kanic Z. Outcome in Patients Resuscitated following Myocardial Infarction with Acute Kidney Injury. Int J Med Sci 2020; 17:1333-1339. [PMID: 32624689 PMCID: PMC7330674 DOI: 10.7150/ijms.45686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/19/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Data on acute kidney injury (AKI) in patients with myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI) after cardiac arrest are scarce. The prevalence of AKI, as classified by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria; and its possible association with 30-day mortality were assessed. Methods: Data on 6387 patients with MI, 342 (5.3%) with out-of-hospital cardiac arrest or arrest immediately after admission before PCI, were retrospectively analyzed. The AKI and no-AKI groups were compared. The 30-day mortality was determined. Results: Ninety-three (27.2%) patients suffered AKI. AKI KDIGO stages 1, 2 and 3 occurred in 45 (13.2%), 8 (2.3%) and 40 (11.7%) patients, respectively. Higher mortality was found in AKI patients [56 (60.2%) vs. no-AKI patients 32 (12.9%); p<0.0001]. More patients died in the higher AKI KDIGO stages. In AKI KDIGO stages 1/2 and stage 3, 20 (37.7%) patients and 36 (90.0%) patients died, respectively compared to 32 (12.9%) no-AKI patients; p<0.0001. AKI was the strongest predictor of 30-day mortality (adjusted OR 6.98; 95% CI 3.42 to 14.23; p<0.0001). Other predictors were bleeding, cardiogenic shock, contrast volume-to-glomerular filtration rate ratio, and female sex. The adjusted OR for AKI KDIGO stages 1/2 and stage 3 were 3.68; 95% CI 1.53 to 8.32; p=0.002 and 29.10; 95% CI 8.31 to 101.88; p<0.0001, respectively. Conclusion: In patients resuscitated after MI undergoing PCI, AKI had a deleterious impact on the prognosis. A graded increase in the severity of AKI according to the KDIGO definition was associated with a progressively increased risk of 30-day mortality.
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Affiliation(s)
- Vojko Kanic
- University Medical Center Maribor, Maribor, Slovenia
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5
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Koutroumpakis E, Gosmanova EO, Stahura H, Jou S, Alreshq R, Ata A, Sidhu MS, Philbin E, Boden WE, Lyubarova R. Attainment of Guideline-Directed Medical Treatment in Stable Ischemic Heart Disease Patients With and Without Chronic Kidney Disease. Cardiovasc Drugs Ther 2020; 33:443-451. [PMID: 31123935 DOI: 10.1007/s10557-019-06883-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Stable ischemic heart disease (SIHD) is prevalent in patients with chronic kidney disease (CKD); however, whether guideline-directed medical therapy (GDMT) is adequately implemented in patients with SIHD and CKD is unknown. HYPOTHESIS Use of GDMT and achievement of treatment targets would be higher in SIHD patients without CKD than in patients with CKD. METHODS This was a retrospective study of 563 consecutive patients with SIHD (mean age 67.8 years, 84% Caucasians, 40% females). CKD was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73m2 using the four-variable MDRD Study equation. We examined the likelihood of achieving GDMT targets (prescription of high-intensity statins, antiplatelet agents, renin-angiotensin-aldosterone system inhibitors (RAASi), and low-density lipoprotein cholesterol levels < 70 mg/dL, blood pressure < 140/90 mmHg, and hemoglobin A1C < 7% if diabetes) in patients with (n = 166) and without CKD (n = 397). RESULTS Compared with the non-CKD group, CKD patients were significantly older (72 vs 66 years; p < 0.001), more commonly female (49 vs 36%; p = 0.002), had a higher prevalence of diabetes (46 vs 34%; p = 0.004), and left ventricular systolic ejection fraction (LVEF) < 40% (23 vs. 10%, p < 0.001). All GDMT goals were achieved in 26% and 24% of patients with and without CKD, respectively (p = 0.712). There were no between-group differences in achieving individual GDMT goals with the exception of RAASi (CKD vs non-CKD: adjusted risk ratio 0.73, 95% CI 0.62-0.87; p < 0.001). CONCLUSIONS Attainment of GDMT goals in SIHD patients with CKD was similar to patients without CKD, with the exception of lower rates of RAASi use in the CKD group.
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Affiliation(s)
- Efstratios Koutroumpakis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Elvira O Gosmanova
- Division of Nephrology and Hypertension, Department of Medicine, Albany Medical College, Albany, NY, USA.,Nephrology Section, Stratton VA Medical Center, Albany, NY, USA
| | - Heather Stahura
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA
| | - Stephanie Jou
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA
| | - Rabah Alreshq
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA
| | - Ashar Ata
- Department of General Surgery, Albany Medical College, Albany, NY, USA
| | - Mandeep S Sidhu
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA
| | - Edward Philbin
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA
| | - William E Boden
- Massachusetts Veterans Epidemiology, Research, and Informatics Center (MAVERIC), VA New England Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Radmila Lyubarova
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA.
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Long-term evaluation of coronary artery calcifications in kidney transplanted patients: a follow up of 5 years. Sci Rep 2019; 9:6869. [PMID: 31053792 PMCID: PMC6499881 DOI: 10.1038/s41598-019-43216-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/17/2019] [Indexed: 12/13/2022] Open
Abstract
Coronary artery calcifications(CACs), are related to the increased cardiovascular mortality during kidney transplantation(KTx). Using coronary-CT performed at 1 month(T0) and 5 years(T5) after KTx we evaluated: (1) the prevalence of CACs; (2) the clinical and biochemical factors related to CACs; 3) the factors implicated with CACs progression. We evaluated 67-pts selected from the 103-pts transplanted in our unit between 2007 and 2008. Clinical and biochemical parameters were recorded at the time of pre-KTx evaluation and for five years after KTx. Coronary-CT for the Agatson score (AS) evaluation was performed at T0 and at T5, and CACs progression was determined. At baseline AS was 45 [0–233]. At T5 AS was 119 [1–413]. At T0, 69% of patients had CACs. Age and dialytic vintage were the main independent variables related to CACs. At T5, CACs were present in 76% of patients. Age was the only independent factor in determining CACs. A progression of CACs was observed in 74% of patients. They were older, had higher CACs-T0 and higher SBP throughout the 5-years. The presence of CACs at T0 and age were the only independent factors in determining the CACs-progression. CACs-T0 had the best discriminative power for CACs progression. CACs prevalence is quite high in KTx patients; Age is strictly related to CACs; Age and the presence of CACs at baseline were the two major factors associated with the progression of CACs during the five years of follow up. CACs-T0 had the best discriminative power for progression of CACs.
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7
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Long-term renal outcomes and mortality following renal injury among myocardial infarction patients treated by primary percutaneous intervention. Coron Artery Dis 2019; 30:87-92. [DOI: 10.1097/mca.0000000000000678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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8
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Kanic V, Kompara G, Suran D, Ekart R, Bevc S, Hojs R. Impact of KDIGO-Defined Acute Kidney Injury on Mortality after Percutaneous Coronary Intervention for Acute Myocardial Infarction. Cardiorenal Med 2018; 8:332-339. [PMID: 30223269 PMCID: PMC6477518 DOI: 10.1159/000492287] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 07/17/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There are limited data regarding the incidence and long-term impact of acute kidney injury (AKI) according to the KDIGO guidelines on the outcome in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI). The aim of the study was to evaluate the prevalence of AKI, as classified by the KDIGO criteria, and its association with long-term mortality. METHODS Data from 5,859 MI patients undergoing PCI at our institution were analyzed. We compared the group without and with AKI according to the KDIGO criteria in relation to long-term mortality. RESULTS AKI was documented in 499 (8.5%) patients. AKI stage 1 occurred in 6.2% of patients, AKI stage 2 in 0.9% of patients, and AKI stage 3 in 1.5% of patients. Patients with AKI had a higher long-term mortality (57.3 vs. 20.6%; p < 0.0001). The mortality was 50.3% in AKI stage 1, 56.9% in AKI stage 2, and 87.2% in AKI stage 3. The hazard ratios for all-cause mortality for AKI stages 1-3 were 1.77, 1.85, and 6.30 compared to patients with no AKI. Cardiogenic shock, bleeding, heart failure, age, renal dysfunction, diabetes, hyperlipidemia, ST-elevation MI, contrast volume/glomerular filtration ratio, P2Y12 receptor antagonists, and radial access were associated with the development of AKI. CONCLUSION A slight increase in serum creatinine was associated with a progressive increase in long-term mortality in patients with AKI according to the KDIGO definition.
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Affiliation(s)
- Vojko Kanic
- Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - Gregor Kompara
- Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - David Suran
- Department of Cardiology and Angiology, University Medical Center Maribor, Maribor, Slovenia
| | - Robert Ekart
- Department of Dialysis, University Medical Center Maribor, Maribor, Slovenia
| | - Sebastjan Bevc
- Department of Nephrology, University Medical Center Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Radovan Hojs
- Department of Nephrology, University Medical Center Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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9
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Rivera-Caravaca JM, Ruiz-Nodar JM, Tello-Montoliu A, Esteve-Pastor MA, Quintana-Giner M, Véliz-Martínez A, Orenes-Piñero E, Romero-Aniorte AI, Vicente-Ibarra N, Pernias-Escrig V, Carrillo-Alemán L, Candela-Sánchez E, Hortelano I, Villamía B, Sandín-Rollán M, Nuñez-Martínez L, Valdés M, Marín F. Disparities in the Estimation of Glomerular Filtration Rate According to Cockcroft-Gault, Modification of Diet in Renal Disease-4, and Chronic Kidney Disease Epidemiology Collaboration Equations and Relation With Outcomes in Patients With Acute Coronary Syndrome. J Am Heart Assoc 2018; 7:JAHA.118.008725. [PMID: 29680822 PMCID: PMC6015275 DOI: 10.1161/jaha.118.008725] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND A simple method to assess renal function is the estimated glomerular filtration rate, and it shows prognostic implications. However, it remains unknown which equation should be used in patients with acute coronary syndrome. We compared the ability and correlation of the Cockcroft-Gault, Modification of Diet in Renal Disease-4 (MDRD-4), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations and their predictive performance for major adverse cardiovascular events, all-cause mortality, and major bleeding in a cohort of patients with acute coronary syndrome. METHODS AND RESULTS Multicenter prospective registry involving 1699 consecutive patients with acute coronary syndrome from 3 tertiary institutions. At entry, renal function was assessed using the Cockcroft-Gault, MDRD-4, and CKD-EPI-creatinine equations. During 12 months of follow-up, we recorded all major adverse cardiovascular events (composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke), bleeding events (Bleeding Academic Research Consortium classification), and all-cause mortality. Receiver operating characteristic curve comparisons demonstrated that Cockcroft-Gault equation had higher predictive ability compared with MDRD-4 equation for major adverse cardiovascular events (0.651 versus 0.616; P=0.023), major bleeding (0.600 versus 0.551; P=0.005), and all-cause mortality (0.754 versus 0.717; P=0.033), as well as higher predictive ability compared with CKD-EPI equation for major bleeding (0.600 versus 0.564; P=0.018). Integrated discrimination improvement and net reclassification improvement analyses showed superior discrimination and reclassification of Cockcroft-Gault equation. Decision curve analyses graphically demonstrated higher net benefit and clinical usefulness of the Cockcroft-Gault equation in comparison with MDRD-4 and CKD-EPI equations. CONCLUSIONS In patients with acute coronary syndrome, the Cockcroft-Gault equation presented superior predictive ability for major adverse cardiovascular events, major bleeding, and all-cause mortality compared with MDRD-4 equation, and superior predictive ability for major bleeding compared with CKD-EPI equation. The Cockcroft-Gault equation also showed higher net benefit and clinical usefulness.
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Affiliation(s)
- José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Juan Miguel Ruiz-Nodar
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Antonio Tello-Montoliu
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Miriam Quintana-Giner
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Andrea Véliz-Martínez
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Ana Isabel Romero-Aniorte
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Nuria Vicente-Ibarra
- Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
| | | | - Luna Carrillo-Alemán
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Elena Candela-Sánchez
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Ignacio Hortelano
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Beatriz Villamía
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Miriam Sandín-Rollán
- Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Laura Nuñez-Martínez
- Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
| | - Mariano Valdés
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Murcia, Spain
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10
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Zeng X, Lincoff AM, Schulz-Schüpke S, Steg PG, Elbez Y, Mehran R, Stone GW, McAndrew T, Lin J, Zhang X, Shi W, Lei H, Jing Z, Huang W. Efficacy and safety of bivalirudin in coronary artery disease patients with mild to moderate chronic kidney disease: Meta-analysis. J Cardiol 2017; 71:494-504. [PMID: 29191630 DOI: 10.1016/j.jjcc.2017.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/28/2017] [Accepted: 10/14/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have elevated bleeding and ischemic outcomes. We aim to assess the short- and long-term efficacy and safety of bivalirudin compared to heparin plus glycoprotein IIb/IIIa inhibitors (GPIs) in coronary artery disease (CAD) patients with CKD. METHODS Randomized trials were searched in PubMed, Cochrane, and Embase databases up to January 2017. Among the trials retrieved, efficacy endpoints were defined as mortality, myocardial infarction (MI), repeat revascularization, stent thrombosis, and major adverse cardiac events (MACEs). Safety endpoints were reported as non-coronary artery bypass grafting (CABG) related major bleeding and thrombolysis in myocardial infarction (TIMI) major bleeding. Risk ratio (RR) and 95% confidence interval (CI) were calculated for each outcome using a fixed effect model. RESULTS Five studies with a total of 3796 patients were included. In short-term follow up (30 days), bivalirudin significantly reduced non-CABG related major bleeding (p=0.0004) and TIMI major bleeding (p=0.007) compared to heparin plus GPIs. No significant differences were observed in rates of mortality, MI, repeat revascularization, stent thrombosis, and MACEs between the two groups in short- and long-term follow up (6 months to 3 years). In patients with ST elevated myocardial infarction (STEMI) with concurrent CKD, the decreased non-CABG related major bleeding (p=0.04) without increasing ischemic events was also observed after short-term follow up. CONCLUSIONS (1) Bivalirudin is safer than and as effective as heparin plus GPIs in CAD patients with CKD. (2) Impaired renal function does not affect the safety benefits of bivalirudin. (3) Similar efficacy profiles were identified between the two groups after both short- and long-term follow up in the CAD patients with CKD.
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Affiliation(s)
- Xiaofang Zeng
- Department of Cardiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | | | - Stefanie Schulz-Schüpke
- ISA Research Center, Deutsches Herzzentrum, Technische Universität, Munich, Germany and German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance
| | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France
| | - Yedid Elbez
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France
| | - Roxana Mehran
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Gregg W Stone
- Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, USA
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - Jianhui Lin
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - Xindan Zhang
- Department of Cardiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Wenhai Shi
- Department of Cardiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Han Lei
- Department of Cardiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Zhicheng Jing
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Huang
- Department of Cardiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China.
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11
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Margolis G, Gal-Oz A, Letourneau-Shesaf S, Khoury S, Keren G, Shacham Y. Acute kidney injury based on the KDIGO criteria among ST elevation myocardial infarction patients treated by primary percutaneous intervention. J Nephrol 2017; 31:423-428. [PMID: 29185210 DOI: 10.1007/s40620-017-0461-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/03/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) following acute ST elevation myocardial infarction (STEMI) is associated with adverse outcomes. The recently proposed KDIGO criteria suggested modifications to the consensus classification system for AKI, namely lowering the threshold of increase in absolute serum creatinine and extending the time frame for AKI detection to 7 days. We evaluated the incidence, risk factors, and long-term mortality associated with AKI as classified by the KDIGO definition in a large single center cohort of consecutive STEMI patients. METHODS We retrospectively studied 2122 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI). Recruited patients were admitted between January 2008 and May 2016 to the cardiac intensive care unit with the diagnosis of acute STEMI. We compared the utilization of the KDIGO and consensus criteria for the diagnosis of AKI and its relation to long term mortality. RESULTS The KDIGO criteria allowed the identification of more patients as having AKI (10.6 vs. 5.6%, p < 0.001) compared to the consensus criteria. Even mild elevation of serum creatinine (≥ 0.3 mg/dL) was associated with a marked increase in all-cause mortality (HR 4.7, 95% CI 3.1-6.43, p < 0.001). Patients with AKI whose renal function resolved prior to hospital discharge still had significantly higher mortality compared to patients with no AKI (23 vs. 8%, HR 3.1, 95% CI 2.09-4.90, p < 0.001). CONCLUSION KDIGO criteria is more sensitive than the consensus criteria in defining AKI in STEMI patients and identifying populations at risk for long term adverse outcomes.
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Affiliation(s)
- Gilad Margolis
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Amir Gal-Oz
- Department of Nephrology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sevan Letourneau-Shesaf
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Shafik Khoury
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel.
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12
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Chakravarthy M. Modifying risks to improve outcome in cardiac surgery: An anesthesiologist's perspective. Ann Card Anaesth 2017; 20:226-233. [PMID: 28393785 PMCID: PMC5408530 DOI: 10.4103/aca.aca_20_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Challenging times are here for cardiac surgical and anesthesia team. The interventional cardiologist seem to have closed the flow of ‘good cases’ coming up for any of the surgery,; successful percutaneous interventions seem to be offering reasonable results in these patients, who therefore do not knock on the doors of the surgeons any more. It is a common experience among the cardiac anesthesiologists and surgeons that the type of the cases that come by now are high risk. That may be presence of comorbidities, ongoing medical therapies, unstable angina, uncontrolled heart failure and rhythm disturbances; and in patients with ischemic heart disease, the target coronaries are far from ideal. Several activities such as institution of preoperative supportive circulatory, ventilatory, and systemic disease control maneuvers seem to have helped improving the outcome of these ‘high risk ‘ patients. This review attempts to look at various interventions and the resulting improvement in outcomes. Several changes have happened in the realm of cardiac surgery and several more are en route. At times, for want of evidence, maximal optimization may not take place and the patient may encounter unfavorable outcomes.. This review is an attempt to bring the focus of the members of the cardiac surgical team on the value of preoperative optimization of risks to improve the outcome. The cardiac surgical patients may broadly be divided into adults undergoing coronary artery bypass graft surgery, valve surgery and pediatric patients undergoing repair/palliation of congenital heart ailments. Optimization of risks appear to be different in each genre of patients. This review also brings less often discussed issues such as anemia, nutritional issues and endocrine problems. The review is an attempt to data on ameliorating modifiable risk factors and altering non modifiable ones.
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Affiliation(s)
- Murali Chakravarthy
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
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13
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Sheu JJ, Ali HEE, Cheng BC, Chiang HJ, Sung PH, Chen KH, Yang CC, Chen YT, Chiang JY, Lin PY, Chua S, Chai HT, Chung SY, Sun CK, Yip HK. Extracorporeal shock wave treatment attenuated left ventricular dysfunction and remodeling in mini-pig with cardiorenal syndrome. Oncotarget 2017; 8:54747-54763. [PMID: 28903379 PMCID: PMC5589618 DOI: 10.18632/oncotarget.18287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/09/2017] [Indexed: 12/24/2022] Open
Abstract
This study tested the hypothesis that extracorporeal shock wave (ECSW) treatment can improve ischemia-induced left ventricular (LV) dysfunction in mini-pig with co-existing chronic kidney disease (CKD). LV ischemia in mini-pigs was induced by applying an ameroid constrictor over mid-left anterior descending artery (LAD), while model of CKD was established by right nephrectomy with partial ligation of left renal arterioles 2 weeks before LAD constriction. Thirty mini-pigs were randomly divided into group 1 (sham-control), group 2 (LV-ischemia), group 3 (LV-ischemia + CKD), Group 4 [LV-ischemia + ECSW (applied 1200 shots at 0.1 mJ/m2/equally to 4-ischemic regions by day-90 after LAD constriction], and group 5 (LV-ischemia-CKD + ECSW). By day-180 after CKD induction, echocardiography showed that LV ejection fraction (LVEF) was highest in group 1, lowest in group 3, significantly lower in group 2 than that in groups 4 and 5, and significantly lower in group 5 than that in group 4, whereas LV-end systolic and diastolic dimensions displayed an opposite pattern (all p<0.001). Protein expressions of oxidative-stress (NOX-1/NOX-2/oxidized protein), apoptotic (cleaved-caspase-3/cleaved-PARP/mitochondrial-Bax), fibrotic (TGF-β/Smad3), pressure/volume-overload (BNP/β-MHC), endothelial (CD31/vWF) and mitochondrial-integrity (PGC-1/mitochondrial-cytochrome-C) biomarkers exhibited a pattern identical to that of LVEF, whereas angiogenesis factors (VEGF/CXCR4/SDF-1α) showed significant progressive increase among all groups (all p<0.0001). Microscopic findings of CD31+cells/vWF+cells/small-vessel density/sarcomere-length showed an identical pattern, whereas collagen-deposition area/fibrotic area/apoptotic nuclei expressed an opposite pattern compared to that of LVEF among all groups (all p<0.0001). In conclusion, CKD aggravated ischemia-induced LV dysfunction and remodeling and molecular-cellular perturbations that were reversed by ECSW treatment.
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Affiliation(s)
- Jiunn-Jye Sheu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hani E E Ali
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Ju Chiang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Hung Chen
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chao Yang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Ta Chen
- Division of Urology, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Pao-Yuan Lin
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sarah Chua
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Han-Tan Chai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Ying Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Nursing, Asia University, Taichung, Taiwan
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Acute kidney injury among ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention: a multifactorial entity. J Nephrol 2016; 29:169-174. [PMID: 26861658 DOI: 10.1007/s40620-015-0255-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/27/2015] [Indexed: 12/16/2022]
Abstract
Acute kidney injury is a frequent complication among ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and is associated with adverse outcomes. While contrast nephropathy is considered the most important reason for worsening of renal function, recent data have suggested the role of other important factors among this specific patient population. In the present review, we examine the various factors leading to renal impairment in STEMI patients and place the findings in the context of this specific patient population in the era of primary PCI. These factors include contrast nephropathy, time to coronary reperfusion, cardiac pump function and hemodynamics as well as various inflammatory and metabolic markers.
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15
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Saad M, Karam B, Faddoul G, Douaihy YE, Yacoub H, Baydoun H, Boumitri C, Barakat I, Saifan C, El-Charabaty E, Sayegh SE. Is kidney function affecting the management of myocardial infarction? A retrospective cohort study in patients with normal kidney function, chronic kidney disease stage III-V, and ESRD. Int J Nephrol Renovasc Dis 2016; 9:5-10. [PMID: 26858529 PMCID: PMC4730996 DOI: 10.2147/ijnrd.s91567] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Patients with chronic kidney disease (CKD) are three times more likely to have myocardial infarction (MI) and suffer from increased morbidity and higher mortality. Traditional and unique risk factors are prevalent and constitute challenges for the standard of care. However, CKD patients have been largely excluded from clinical trials and little evidence is available to guide evidence-based treatment of coronary artery disease in patients with CKD. Our objective was to assess whether a difference exists in the management of MI (ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction) among patients with normal kidney function, CKD stage III–V, and end-stage renal disease (ESRD) patients. We conducted a retrospective cohort study on patients admitted to Staten Island University Hospital for the diagnosis of MI between January 2005 and December 2012. Patients were assigned to one of three groups according to their kidney function: Data collected on the medical management and the use of statins, platelet inhibitors, beta-blockers, and angiotensin converting enzyme inhibitors/angiotensin receptor blockers were compared among the three cohorts, as well as medical interventions including: catheterization and coronary artery bypass graft (CABG) when indicated. Chi-square test was used to compare the proportions between nominal variables. Binary logistic analysis was used in order to determine associations between treatment modalities and comorbidities, and to account for possible confounding factors. Three hundred and thirty-four patients (mean age 67.2±13.9 years) were included. In terms of management, medical treatment was not different among the three groups. However, cardiac catheterization was performed less in ESRD when compared with no CKD and CKD stage III–V (45.6% vs 74% and 93.9%) (P<0.001). CABG was performed in comparable proportions in the three groups and CABG was not associated with the degree of CKD (P=0.078) in binary logistics regression. Cardiac catheterization on the other hand carried the strongest association among all studied variables (P<0.001). This association was maintained after adjusting for other comorbidities. The length of stay for the three cohorts (non-CKD, CKD stage III–V, and ESRD on hemodialysis) was 16, 17, and 15 days, respectively and was not statistically different. Many observations have reported discrimination of care for patients with CKD considered suboptimal candidates for aggressive management of their cardiac disease. In our study, medical therapy was achieved at high percentage and was comparable among groups of different kidney function. However, kidney disease seems to affect the management of patients with acute MI; percutaneous coronary angiography is not uniformly performed in patients with CKD and ESRD when compared with patients with normal kidney function.
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Affiliation(s)
- Marc Saad
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Boutros Karam
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Geovani Faddoul
- Department of Nephrology, Icahn School of Medicine, New York, NY, USA
| | - Youssef El Douaihy
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Harout Yacoub
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Hassan Baydoun
- Department of Cardiology, Tulane University Medical Center, New Orleans, LA, USA
| | - Christine Boumitri
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Iskandar Barakat
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Chadi Saifan
- Department of Nephrology, Staten Island University Hospital, Staten Island, NY, USA
| | - Elie El-Charabaty
- Department of Nephrology, Staten Island University Hospital, Staten Island, NY, USA
| | - Suzanne El Sayegh
- Department of Nephrology, Staten Island University Hospital, Staten Island, NY, USA
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