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Pacilli G, Piscitelli P, D'Errico MM, Mangiacotti A, Siena A, Buglio AL, Vendemiale G, Fontana A, Copetti M, Mirijello A, De Cosmo SA. Association between R 2CHA 2DS 2-VASc score and three-vessel coronary artery disease in a large population at high cardiovascular risk. Intern Emerg Med 2024:10.1007/s11739-024-03679-4. [PMID: 38970758 DOI: 10.1007/s11739-024-03679-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/11/2024] [Indexed: 07/08/2024]
Abstract
Coronary artery disease (CAD), particularly three-vessel coronary disease (3VD), is the main cause of death in industrialized countries. Chronic kidney disease is an independent risk factor for CAD. The CHA2DS2-VASc score shows a good ability to predict CV events in high-risk population independently from atrial fibrillation. The aim of the present study was to evaluate the association between the R2CHA2DS2-VASc score and 3VD in a population of patients at high cardiovascular risk. Monocentric prospective study evaluated 1017 patients undergoing coronary angiography. The R2CHA2DS2-VASc score was obtained by adding 2 points to the CHA2DS2-VASc score in case of eGFR < 60 ml/min/1.73m2. Coronary lesions causing ≥ 50% reduction of a major epicardial vessel diameter were considered significant. Patients were grouped based on R2CHA2DS2-VASc tertiles and according to the severity of CAD: 3VD vs No-3VD. The 3VD group showed significantly higher R2CHA2DS2-VASc score than the No-3VD group (4.20 ± 2.18 vs 3.36 ± 2.06, p < 0.001). The risk of 3VD increased by 21% for every 1-point increase in the score (OR 1.21; 95% CI 1.13-1.28, p < 0.001). The prevalence of 3VD was higher among patients belonging to higher tertiles of R2CHA2DS2-VASc (17.2% vs 26.7% vs 33.6% for first, second, and third tertile respectively, p < 0.001) with a risk more than doubled for the third tertile compared to the first one (OR 2.45; 95% CI 1.71-3.49, p < 0.001). The R2CHA2DS2-VASc score is independently associated with 3VD in patients at high cardiovascular risk. The score could be considered a useful tool for clinicians to identify patients who are at high risk of 3VD.
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Affiliation(s)
- Gabriella Pacilli
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Pamela Piscitelli
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Maria Maddalena D'Errico
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Antonio Mangiacotti
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Antonio Siena
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Aurelio Lo Buglio
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Gianluigi Vendemiale
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo Della Sofferenza, Viale Cappuccini, 71013, San Giovanni Rotondo, Italy
| | - Antonio Mirijello
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy.
| | - Salvatore A De Cosmo
- Units of Internal Medicine, Fondazione IRCCS Casa Sollievo Della Sofferenza, viale Cappuccini, 71013, San Giovanni Rotondo, Italy.
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Zhao M, Huang X, Zhang Y, Wang Z, Zhang S, Peng J. Predictive value of the neutrophil percentage-to-albumin ratio for coronary atherosclerosis severity in patients with CKD. BMC Cardiovasc Disord 2024; 24:277. [PMID: 38807036 PMCID: PMC11134736 DOI: 10.1186/s12872-024-03896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The neutrophil percentage-to-albumin ratio (NPAR), which is defined as the percentage of neutrophils divided by the concentration of albumin, is a cost-effective and readily available biomarker of inflammation. This study aimed to evaluate the association between the NPAR and the severity of coronary atherosclerosis in patients with chronic kidney disease (CKD). METHODS A total of 280 CKD patients who underwent coronary angiography were retrospectively enrolled in this study. The severity of coronary atherosclerosis was evaluated using the Gensini score (GS). Patients were divided into low-, medium- and high-NPAR groups according to the tertiles of the NPAR values. Logistic regression analysis was conducted to analyze the relationship between the NPAR and the GS. The cutoff points for the sensitivity and specificity of the NPAR in predicting the GS were estimated via receiver operating characteristic (ROC) analysis. RESULTS There was a higher prevalence of coronary artery disease (CAD) among CKD patients with higher NPARs (P =0.041). More patients in the high-NPAR group had complex CAD (triple-vessel disease and/or left main coronary artery stenosis) and chronic total occlusion lesions, and more of these patients required revascularization therapy (P<0.05). Multivariate logistic regression analysis revealed a significant positive correlation between the NPAR and the severity of coronary stenosis (adjusted OR 2.68, 95% CI 1.25-5.76, p=0.012), particularly among female and older (age ≥65) patients. The ROC analysis indicated that the optimal cutoff value for the NPAR in predicting severe coronary artery stenosis (GS>60) in CKD patients was 1.91 (sensitivity 0.495, specificity 0.749), with an area under the curve (AUC) of 0.650 (95% CI 0.581-0.719, P<0.001). A subgroup analysis according to sex revealed that the NPAR exhibited stronger predictive value in female patients (AUC 0.730, 95% CI 0.643-0.817) than in male patients (AUC 0.565, 95% CI 0.460-0.670) (P<0.001), and the optimal cutoff value for the NPAR in female patients was 1.80 (sensitivity 0.667, specificity 0.705). CONCLUSIONS Our study demonstrated that the NPAR is independently associated with the severity of coronary atherosclerosis in CKD patients, especially in female and elderly patients (≥65 years old). Moreover, the NPAR can effectively predict the severity of coronary atherosclerosis, exhibiting greater predictive value in females than in males.
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Affiliation(s)
- Mengqi Zhao
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Xin Huang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yang Zhang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Zuoyan Wang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Songli Zhang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Jianjun Peng
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
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Jin J, Woo H, Jang Y, Lee WK, Kim JG, Lee IK, Park KG, Choi YK. Novel Asian-Specific Visceral Adiposity Indices Are Associated with Chronic Kidney Disease in Korean Adults. Diabetes Metab J 2023; 47:426-436. [PMID: 36872065 PMCID: PMC10244194 DOI: 10.4093/dmj.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/17/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND The Chinese visceral adiposity index (CVAI) and new visceral adiposity index (NVAI) are novel indices of visceral adiposity used to predict metabolic and cardiovascular diseases in Asian populations. However, the relationships of CVAI and NVAI with chronic kidney disease (CKD) have not been investigated. We aimed to characterize the relationships of CVAI and NVAI with the prevalence of CKD in Korean adults. METHODS A total of 14,068 participants in the 7th Korea National Health and Nutrition Examination Survey (6,182 men and 7,886 women) were included. Receiver operating characteristic (ROC) analyses were employed to compare the associations between indices of adiposity and CKD, and a logistic regression model was used to characterize the relationships of CVAI and NVAI with CKD prevalence. RESULTS The areas under the ROC curves for CVAI and NVAI were significantly larger than for the other indices, including the visceral adiposity index and lipid accumulation product, in both men and women (all P<0.001). In addition, high CVAI or NVAI was significantly associated with a high CKD prevalence in both men (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.31 to 3.48 in CVAI and OR, 6.47; 95% CI, 2.91 to 14.38 in NVAI, P<0.05) and women (OR, 4.87; 95% CI, 1.85 to 12.79 in CVAI and OR, 3.03; 95% CI, 1.35 to 6.82 in NVAI, P<0.05); this association remained significant after adjustment for multiple confounding factors in men and women. CONCLUSION CVAI and NVAI are positively associated with CKD prevalence in a Korean population. CVAI and NVAI may be useful for the identification of CKD in Asian populations, including in Korea.
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Affiliation(s)
- Jonghwa Jin
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Hyein Woo
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Youngeun Jang
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Won-Ki Lee
- Center of Biostatistics, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Jung-Guk Kim
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - In-Kyu Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Keun-Gyu Park
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Yeon-Kyung Choi
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
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Xu F, Wang G, Ye N, Bian W, Yang L, Ma C, Zhao D, Liu J, Hao Y, Liu J, Yang N, Cheng H. Mild renal insufficiency and attributable risk of adverse In-hospital outcomes in patients with Acute Coronary Syndrome from the improving care for Cardiovascular Disease in China (CCC) project. BMC Nephrol 2022; 23:29. [PMID: 35027003 PMCID: PMC8759171 DOI: 10.1186/s12882-022-02663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Renal insufficiency (RI) is a frequent comorbidity among patients with acute coronary syndrome (ACS). We aimed to evaluate the attributable risk associated with mild RI for the in-hospital outcomes in patients with ACS. Methods The Improving Care for Cardiovascular Disease in China-ACS (CCC-ACS) Project was a collaborative study of the American Heart Association and the Chinese Society of Cardiology. A total of 92,509 inpatients with a discharge diagnosis of ACS were included. The attributable risk was calculated to investigate the effect of mild RI (eGFR 60-89 ml / min · 1.73 m2) on major adverse cardiovascular events (MACEs) during hospitalization. Results The average age of these ACS patients was 63 years, and 73.9% were men. The proportion of patients with mild RI was 36.17%. After adjusting for other possible risk factors, mild RI was still an independent risk factor for MACEs in ACS patients. In the ACS patients, the attributable risk of eGFR 60-89ml/min·1.73m2 to MACEs was 7.78%, 4.69% of eGFR 45-59 ml/min·1.73m2, 4.46% of eGFR 30-44 ml/min·1.73m2, and 3.36% of eGFR<30 ml/min·1.73m2. Conclusion Compared with moderate to severe RI, mild RI has higher attributable risk to MACEs during hospitalization in Chinese ACS population. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02663-4.
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Beta 2-Microglobulin and the Severity of Coronary Stenosis in Patients With Acute Coronary Syndrome. Heart Lung Circ 2019; 28:575-582. [DOI: 10.1016/j.hlc.2018.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/20/2018] [Indexed: 11/23/2022]
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Zhang C, Liu P, Xia K, Fang H, Jiang M, Xie Q, Yu Z, Yang T. Association of Serum Prealbumin with Angiographic Severity in Patients with Acute Coronary Syndrome. Med Sci Monit 2017; 23:4041-4049. [PMID: 28827514 PMCID: PMC5574376 DOI: 10.12659/msm.902348] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Serum prealbumin (PA), which is a nutritional index, has been found to be associated with severities and prognoses of various diseases. However, there are no reports about the relationship between PA and angiographic severity of coronary artery disease. Material/Methods This cross-sectional study included 867 patients with acute coronary syndrome (ACS) who underwent coronary angiography. Patients were divided into quartiles of PA and coronary artery stenosis was determined by angiographic Gensini score, the presence of high Gensini score (Gensini score ≥120), and triple-vessel disease. Multivariate linear and logistic regression analyses were performed to explore the relationship between PA and disease severity in a coronary angiogram. Results There was a significant and independent negative correlation between PA and Gensini score in multivariate linear regression (p=0.015). Logistic regression analysis revealed that crude odds ratios of triple-vessel disease and high Gensini score were 2.47 (95% CI: 1.66–3.67) and 1.83 (95% CI: 1.50–3.49), respectively, in the first quartile of PA compared with the fourth quartile and the results remained significant for high Gensini score after adjustment for confounding factors. In addition, estimated glomerular filtration rate, liver function, and high-sensitivity C-reactive protein (hs-CRP) had no interactive relationships in the above associations. Patients with lower levels of albumin or higher levels of hs-CRP or the ratio of hs-CRP to PA (hs-CRP/PA) also had more severe coronary atherosclerosis. Conclusions PA is negatively and independently associated with angiographic severity in patients with ACS, indicating for potential use in estimating the burden of coronary atherosclerosis.
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Affiliation(s)
- Chenglong Zhang
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Pei Liu
- Department of Cardiology, The 3rd Hospital of Changsha, Changsha, Hunan, China (mainland)
| | - Ke Xia
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Han Fang
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Minna Jiang
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Qiying Xie
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Zaixin Yu
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Tianlun Yang
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
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Verdoia M, Barbieri L, Schaffer A, Bellomo G, Marino P, De Luca G. Impact of renal function on mean platelet volume and its relationship with coronary artery disease: A single-centre cohort study. Thromb Res 2016; 141:139-44. [PMID: 27039166 DOI: 10.1016/j.thromres.2016.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mean platelet volume (MPV) has been proposed as a marker of platelet reactivity and cardiovascular disease. Chronic kidney disease (CKD) significantly favors the occurrence of cardiovascular events, by increasing the circulating levels of a wide spectrum of pro-oxidant and pro-thrombotic mediators. However, opposite alterations of platelet function, both enhanced aggregability and increased bleeding diathesis have been reported in these patients, with contrasting results on the effects of renal function on MPV and coronary artery disease, that were assessed in present study. METHODS In patients undergoing coronary angiography, MPV and renal function (serum creatinine and estimated Glomerular Filtration Rate, eGFR, by MDRD formula) were assessed at admission. Coronary artery disease (CAD) was defined as a stenosis >50% in at least 1 coronary vessel, while severe CAD as left main or trivessel disease. RESULTS Among 3712 patients, 1044 (28.1%) had chronic kidney disease. CKD was related with age, female gender, diabetes and glycemic control, history of myocardial infarction, cerebrovascular accidents, coronary artery bypass grafting and left ventricular dysfunction or arrhythmias as indication to angiography, therapy with angiotensin-receptor blockers, nitrates, diuretics and calcium-antagonists, but lower rate of smoking, lower fibrinogen levels, haemoglobin, total and HDL cholesterol (p<0.001, respectively). CKD patients displayed increased severity and complexity of CAD (p<0.001) and significantly larger platelet volume (p<0.001), with CKD resulting as independent predictor of MPV above the median (≥10.85fl; Adjusted OR[95%CI]=1.56[1.23,1.99], p=0.002). Moreover, in the 1044 patients with renal failure, higher platelet volume (above the median value; ≥10.85fl) was associated with age (p=0.05), haemoglobin levels and platelet count (p<0.001), but not to a higher prevalence or extent of coronary artery disease (CAD: adjusted OR[95%CI]=0.80[0.58-1.09], p=0.16; severe CAD, adjusted OR[95%CI]=1.07[0.81-1.41], p=0.65). CONCLUSIONS Higher values of MPV are observed among patients with chronic kidney disease, inversely relating to eGFR. However, larger platelet size does not contribute to explain the increased severity of coronary artery disease observed among these patients.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy
| | - Lucia Barbieri
- Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy
| | - Alon Schaffer
- Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy
| | - Giorgio Bellomo
- Clinical Chemistry, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy; Departement of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | - Paolo Marino
- Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy; Departement of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | - Giuseppe De Luca
- Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy; Departement of Translational Medicine, Eastern Piedmont University, Novara, Italy; Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy.
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Zhang QB, Chen LM, Li M, Cui YQ, Zhao CY, Cui LQ. Influence of chronic kidney disease on the outcome of patients with chronic total occlusion. Am J Transl Res 2016; 8:196-208. [PMID: 27069553 PMCID: PMC4759429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/24/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Chronic kidney disease (CKD) predicted a poor prognosis in patients with coronary artery disease. There is a paucity of data on outcomes after revascularization in patients with chronic total occlusion (CTO) and CKD. This study aims to investigate the impact of CKD on the revascularization of CTO. METHODS This study enrolled 1,092 CTO patients received treatments in our hospital between February 2009 and January 2014. Major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality were compared to evaluate medium- and long-term outcomes. Median follow-up was 39 months (interquartile range, 27-52 months). RESULT CKD decreased cumulative MACCE-free survival rate (54.4 ± 6.2% vs. 70.9 ± 2.5%, P < 0.001) and cumulative survival rate (68.6 ± 6.3% vs. 90.5 ± 1.6%, P < 0.001). Revascularization was associated with better outcomes among patients with (MACCE-free survival rate: 64.8 ± 5.7% vs. 20.1 ± 15.3%, P = 0.009; survival rate 78.4 ± 5.6% vs. 38.7 ± 17.4%, P = 0.006) or without CKD (MACCE-free survival rate 73.9 ± 2.7% vs. 61.0 ± 5.4%, P = 0.001; survival rate 92.9 ± 1.5% vs. 83.8 ± 4.0%, P = 0.009). The benefit from revascularization was attenuated by CKD. Compared with percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) had similar cumulative survival rates among patients, whether with or without CKD, but was associated with a higher cumulative MACCE-free survival rate (80.5 ± 3.4% vs. 68.5 ± 4.0%, P = 0.017) among patients without CKD. CONCLUSION CKD attenuated the benefit from revascularization for CTO. Moreover, CABG was not superior to PCI among CTO patients, but with a reduction in MACCE in patients without CKD.
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Affiliation(s)
- Qing-Bin Zhang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021, PR China
| | - Li-Ming Chen
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021, PR China
| | - Min Li
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021, PR China
| | - Yu-Qi Cui
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021, PR China
| | - Chuan-Yan Zhao
- Yidu Central Hospital of WeifangWeifang 262500, PR China
| | - Lian-Qun Cui
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021, PR China
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Nishida J, Kokubu N, Kawamukai M, Hashimoto A, Ohnishi H, Kouzu H, Ohnuma Y, Hasegawa T, Tsuchida A, Miura T. Does a Reduction in the Glomerular Filtration Rate Increase the Overall Severity of Coronary Artery Stenosis? Intern Med 2016; 55:871-7. [PMID: 27086798 DOI: 10.2169/internalmedicine.55.5198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Chronic kidney disease is a risk factor of coronary events, however, its impact on coronary artery stenosis has not yet been clarified with the use of a large database. We examined the association between a reduced glomerular filtration rate (GFR) and the overall severity of coronary stenosis. METHODS We enrolled 1,150 patients [mean age, 68±12 (SD) years; 66.6% men] who consecutively underwent coronary angiography for suspected stable angina pectoris. The overall severity of stenosis in the coronary arteries was assessed by the Gensini score (GS), and its logarithmic values (log-GS) were used for statistical analyses since the GS does not follow a normal distribution. RESULTS The log-GS was significantly larger in men than in women (2.5±1.5 vs. 1.9±1.7), while the estimated GFR (eGFR) and comorbidities were comparable between both sexes. A multivariate regression analysis indicated that age, smoking, eGFR, HDL-cholesterol and HbA1c were independent explanatory variables of the log-GS in men, although the eGFR explained only 1.2% of the log-GS variation. In women, the eGFR was not included in the significant explanatory variables shown by the multivariate analysis. However, the sex difference in the regression for the eGFR-log-GS relationship was not statistically significant. CONCLUSION A reduced eGFR is a significant, but minor, determinant of the overall severity of coronary artery stenosis in men and potentially women.
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Affiliation(s)
- Junichi Nishida
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Japan
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Burlacu A, Siriopol D, Voroneanu L, Nistor I, Hogas S, Nicolae A, Nedelciuc I, Tinica G, Covic A. Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single-Center Study (REN-ACS)—A Single Center, Prospective, Observational Study. J Am Heart Assoc 2015; 4:e002379. [PMID: 26459932 PMCID: PMC4845148 DOI: 10.1161/jaha.115.002379] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background We are the first to evaluate the prevalence of renal artery stenosis (RAS) in consecutive patients with acute myocardial infarction (AMI) referred for primary percutaneous coronary intervention from a single tertiary center. As a novelty, we assessed hydration and metabolic status and measured arterial stiffness. We elaborated a predicting model for RAS in AMI. Methods and Results One hundred and eighty‐one patients with AMI underwent concomitantly primary percutaneous coronary intervention and renal angiography. We obtained data on demographics, medical history, cardiovascular risk factors, echocardiography, Killip class, and blood tests. In the first 24 hours post–primary percutaneous coronary intervention, we assessed bioimpedance through Body Composition Monitoring® and arterial stiffness through pulsed‐wave velocity, SphygmoCor®. Significant RAS (>50% lumen narrowing, RAS+) was present in 16.6% patients. In the RAS+ group we recorded significantly higher stiffness, CRUSADE score and dehydration, and more women with higher prevalence of multivascular coronary artery disease and heart failure. In our multivariate models, variables independently associated with RAS+ were previous percutaneous coronary intervention, low estimated glomerular filtration rate, multivascular coronary artery disease, and total/extracellular body water. These models had good specificity and low sensitivity. Conclusions We observed that RAS+ AMI patients have a particular hydration, metabolic, and endothelial profile that could generate more future major adverse cardiac events. Hence, renal angiography in AMI should be considered in specific subsets of patients. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02388139.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania (A.B., I.N.)
| | - Dimitrie Siriopol
- Department of Nephrology, University of Medicine "Gr. T. Popa", Iasi, Romania (D.S., L.V., I.N., S.H., A.C.)
| | - Luminita Voroneanu
- Department of Nephrology, University of Medicine "Gr. T. Popa", Iasi, Romania (D.S., L.V., I.N., S.H., A.C.)
| | - Ionut Nistor
- Department of Nephrology, University of Medicine "Gr. T. Popa", Iasi, Romania (D.S., L.V., I.N., S.H., A.C.)
| | - Simona Hogas
- Department of Nephrology, University of Medicine "Gr. T. Popa", Iasi, Romania (D.S., L.V., I.N., S.H., A.C.)
| | - Ana Nicolae
- Department of Cardiology, Cardiovascular Diseases Institute, Iasi, Romania (A.N.)
| | - Igor Nedelciuc
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania (A.B., I.N.)
| | - Grigore Tinica
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, Iasi, Romania (G.T.)
| | - Adrian Covic
- Department of Nephrology, University of Medicine "Gr. T. Popa", Iasi, Romania (D.S., L.V., I.N., S.H., A.C.)
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Association of renal function, estimated by four equations, with coronary artery disease. Int Urol Nephrol 2015; 47:663-71. [DOI: 10.1007/s11255-015-0935-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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12
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Kang HW, Seo SP, Kim WT, Kim YJ, Yun SJ, Lee SC, Kim WJ. Effect of renal insufficiency on stone recurrence in patients with urolithiasis. J Korean Med Sci 2014; 29:1132-7. [PMID: 25120325 PMCID: PMC4129207 DOI: 10.3346/jkms.2014.29.8.1132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 05/07/2014] [Indexed: 11/20/2022] Open
Abstract
The study was designed to assess the relationship between glomerular filtration rate (GFR) and urinary stone-forming constituents, and to assess the effect of renal insufficiency on stone recurrence risk in first stone formers (SF). Baseline serum creatinine levels were obtained, and renal insufficiency was defined as creatinine clearance ≤60 mL/min (Cockroft-Gault). This retrospective case-control study consists of 342 first SF; 171 SF with normal renal function were selected with 1:1 propensity scores matched to 171 SF with renal insufficiency. Urinary metabolic evaluation was compared to renal function. GFR was positively correlated with urinary calcium, uric acid, and citrate excretion. Subjects with renal insufficiency had significantly lower urinary calcium, uric acid, and citrate excretion than those with normal renal function, but not urine volume. With regard to urinary metabolic abnormalities, similar results were obtained. SF with renal insufficiency had lower calcium oxalate supersaturation indexes and stone recurrence rates than SF with normal renal function. Kaplan-Meier curves showed similar results. In conclusion, GFR correlates positively with urinary excretion of stone-forming constituents in SF. This finding implies that renal insufficiency is not a risk factor for stone recurrence.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Sung Phil Seo
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Yong-June Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Seok-Joong Yun
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Sang-Cheol Lee
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Wun-Jae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
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