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Lizama PM, Ríos DL, Cachinero IS, Lopez-Egea AT, Camps A, Belzares O, Pacheco C, Cerro C, Wehinger S, Fuentes E, Marrugat J, Palomo I. Association of Kidney Disease, Potassium, and Cardiovascular Risk Factor Prevalence with Coronary Arteriosclerotic Burden, by Sex. J Pers Med 2021; 11:722. [PMID: 34442366 PMCID: PMC8400373 DOI: 10.3390/jpm11080722] [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: 05/11/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/03/2022] Open
Abstract
The present study aimed to determine the relationship between the prevalence of cardiovascular risk factors and the number and severity of coronary artery atherosclerotic lesions obtained by coronary angiography. We reviewed and analyzed 1642 records from consecutive patients at the Catheter Laboratory of Talca Regional Hospital in Chile between March 2018 and May 2019. Patients were stratified according to the presence and severity of atherosclerotic lesions: 632 (38.5%) had no lesions or <30% stenosis and 1010 (61.5%) had at least one coronary atherosclerotic lesion with ≥30% stenosis (CALS-30). CALS-30 was more frequent in males, smokers, and patients with diabetes and/or hypertension (all p-values < 0.02). Serum potassium, glycaemia, creatinine and glomerular filtration rates were also associated with CALS-30 (all p-values < 0.01) in males. The age and the proportion of males with CALS-30 increased with the number of risk factors (p-values for trends < 0.001). Our results showed a stronger association between the accumulation of risk factors and CALS-30 in women than in men. Serum potassium levels were inversely associated with CALS-30 in men but not in women.
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Affiliation(s)
- Patricio Maragaño Lizama
- Unidad de Hemodinamia, Hospital Regional de Talca, Talca 3460000, Chile; (P.M.L.); (O.B.); (C.P.); (C.C.)
| | - Diana L. Ríos
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Medical Technology School, Universidad de Talca, Talca 3460000, Chile;
| | - Isaac Subirana Cachinero
- REGICOR Research Group, IMIM (Hospital del Mar Medical Research Institute), 08025 Barcelona, Spain; (I.S.C.); (A.T.L.-E.); (A.C.); (J.M.)
- CIBERESP de Investigación en Epidemiología y Salud Pública, 28001 Madrid, Spain
| | - Andrea Toloba Lopez-Egea
- REGICOR Research Group, IMIM (Hospital del Mar Medical Research Institute), 08025 Barcelona, Spain; (I.S.C.); (A.T.L.-E.); (A.C.); (J.M.)
| | - Anna Camps
- REGICOR Research Group, IMIM (Hospital del Mar Medical Research Institute), 08025 Barcelona, Spain; (I.S.C.); (A.T.L.-E.); (A.C.); (J.M.)
| | - Oward Belzares
- Unidad de Hemodinamia, Hospital Regional de Talca, Talca 3460000, Chile; (P.M.L.); (O.B.); (C.P.); (C.C.)
| | - Claudio Pacheco
- Unidad de Hemodinamia, Hospital Regional de Talca, Talca 3460000, Chile; (P.M.L.); (O.B.); (C.P.); (C.C.)
| | - Cristina Cerro
- Unidad de Hemodinamia, Hospital Regional de Talca, Talca 3460000, Chile; (P.M.L.); (O.B.); (C.P.); (C.C.)
| | - Sergio Wehinger
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Medical Technology School, Universidad de Talca, Talca 3460000, Chile;
| | - Eduardo Fuentes
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Medical Technology School, Universidad de Talca, Talca 3460000, Chile;
| | - Jaume Marrugat
- REGICOR Research Group, IMIM (Hospital del Mar Medical Research Institute), 08025 Barcelona, Spain; (I.S.C.); (A.T.L.-E.); (A.C.); (J.M.)
- CIBERESP de Investigación en Epidemiología y Salud Pública, 28001 Madrid, Spain
- CIBERCV de Investigación en Enfermedades Cardiovasculares, 28001 Madrid, Spain
| | - Iván Palomo
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Medical Technology School, Universidad de Talca, Talca 3460000, Chile;
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The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study. Int Urol Nephrol 2021; 53:2557-2566. [PMID: 33599901 PMCID: PMC8599341 DOI: 10.1007/s11255-021-02794-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/08/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS. METHODS In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1-53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m2; 29.8%) and group 2-125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%). RESULTS In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG. CONCLUSION Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.
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Gelsomino S, Bonacchi M, Lucà F, Barili F, Del Pace S, Parise O, Johnson DM, Gulizia MM. Comparison between three different equations for the estimation of glomerular filtration rate in predicting mortality after coronary artery bypass. BMC Nephrol 2019; 20:371. [PMID: 31619211 PMCID: PMC6796478 DOI: 10.1186/s12882-019-1564-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 09/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background This study was undertaken to compare the accuracy of chronic kidney disease-epidemiology collaboration (eGFRCKD-EPI) to modification of diet in renal disease (eGFRMDRD) and the Cockcroft-Gault formulas of Creatinine clearance (CCG) equations in predicting post coronary artery bypass grafting (CABG) mortality. Methods Data from 4408 patients who underwent isolated CABG over a 11-year period were retrieved from one institutional database. Discriminatory power was assessed using the c-index and comparison between the scores’ performance was performed with DeLong, bootstrap, and Venkatraman methods. Calibration was evaluated with calibration curves and associated statistics. Results The discriminatory power was higher in eGFRCKD-EPI than eGFRMDRD and CCG (Area under Curve [AUC]:0.77, 0.55 and 0.52, respectively). Furthermore, eGFRCKD-EPI performed worse in patients with an eGFR ≤29 ml/min/1.73m2 (AUC: 0.53) while it was not influenced by higher eGFRs, age, and body size. In contrast, the MDRD equation was accurate only in women (calibration statistics p = 0.72), elderly patients (p = 0.53) and subjects with severe impairment of renal function (p = 0.06) whereas CCG was not significantly biased only in patients between 40 and 59 years (p = 0.6) and with eGFR 45–59 ml/min/1.73m2 (p = 0.32) or ≥ 60 ml/min/1.73m2 (p = 0.48). Conclusions In general, CKD-EPI gives the best prediction of death after CABG with unsatisfactory accuracy and calibration only in patients with severe kidney disease. In contrast, the CG and MDRD equations were inaccurate in a clinically significant proportion of patients.
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Affiliation(s)
- Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Florence, Italy. .,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229, ER, Maastricht, The Netherlands.
| | - Massimo Bonacchi
- Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Fabiana Lucà
- Cardiothoracic Department, Maastricht University Hospital, Florence, Italy.,ANMCO Research Center of Heart Care, Florence, Italy
| | - Fabio Barili
- Department of Cardiovascular Surgery, S. Croce Hospital, Cuneo, Italy
| | - Stefano Del Pace
- Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Orlando Parise
- Cardiothoracic Department, Maastricht University Hospital, Florence, Italy
| | - Daniel M Johnson
- Cardiothoracic Department, Maastricht University Hospital, Florence, Italy
| | - Michele Massimo Gulizia
- ANMCO Research Center of Heart Care, Florence, Italy.,Cardiology Garibaldi-Nesima Hospital, Catania, Italy
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Tomaszuk-Kazberuk A, Nikas D, Lopatowska P, Młodawska E, Malyszko J, Bachorzewska-Gajewska H, Dobrzycki S, Sobkowicz B, Goudevenos I. Patients with Atrial Fibrillation and Chronic Kidney Disease More Often Undergo Angioplasty of Left Main Coronary Artery - a 867 Patient Study. Kidney Blood Press Res 2018; 43:1796-1805. [PMID: 30504712 DOI: 10.1159/000495637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Several studies have implicated atrial fibrillation (AF) as a contributing factor in chronic kidney disease (CKD) and cardiovascular events. The prevalence of coronary artery disease (CAD) in patients with AF varies substantially from 17% to 46.5%. There are only few studies concerning renal function in population with AF undergoing coronary angiography. The aim of the present study was to assess which type of AF is dominant in CKD population scheduled for coronary angiography and if it can influence patients' outcome, the association between renal impairment and the type of coronary procedures in AF patients and the influence of renal function on in-hospital mortality. METHODS We retrospectively studied 867 patients with AF hospitalized due to coronary angiography in two year time. The cut off value of CKD was eGFR ≤ 60 ml/min./1.73m2 evaluated by CKD-EPI formula. RESULTS A total of 867 patients with AF (44% women; mean age 72±10 years) were included in the analysis. The mean eGFR was 44±11ml/min./1.73m2 in patients with CKD and 89±18 ml/min./1.73m2 in patients with preserved renal function. Patients with CKD and AF were older (p< 0.001), had more often diabetes (p=0.009), heart failure (p< 0.001) and anaemia (p< 0.001). Patients with CKD and AF had more often permanent type of AF (p< 0.001). In CKD patients CHA2DS2VASc score was 4.3±1.5 and HAS-BLED score was 2.0±1.2 and it was significantly higher as compared to population with preserved renal function (p< 0.001, p=0.02, respectively). The use of oral anticoagulation was less frequent in CKD group (p< 0.001) although these patients had higher CHA2DS2VASc score. Patients with AF and CKD were more often admitted due to myocardial infarction (STEMI or NSTEMI) (p=0.02, p< 0.001, respectively) and more often underwent percutaneous coronary intervention (PCI) (p=0.01). Among coronary arteries the percutaneous coronary intervention (PCI) of left main artery was done more frequently in CKD patients (p=0.01). Among CKD population in-hospital mortality was significantly higher in patients with eGFR < 30 ml/min (p< 0.001). CONCLUSION Patients with CKD had more often permanent type of AF. Percutaneous interventions of the left main coronary artery, the only elective procedures influencing patients' prognosis, were done more frequently in CKD patients with AF. In-hospital mortality was significantly higher in patients with severe renal impairment. Despite the higher risk of ischaemic stroke in CKD group the use of oral anticoagulation therapy was significantly less frequent and the patients were deprived of the confirmed benefits of such treatment.
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Affiliation(s)
| | - Dimitrios Nikas
- Cardiology Department, Ioannina University Hospital, Ioannina, Greece
| | - Paulina Lopatowska
- Department of Cardiology, Medical University in Bialystok, Bialystok, Poland
| | - Elzbieta Młodawska
- Department of Cardiology, Medical University in Bialystok, Bialystok, Poland
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Hanna Bachorzewska-Gajewska
- Department of Invasive Cardiology, Medical University in Bialystok, Bialystok, Poland.,Department of Clinical Medicine, Medical University in Bialystok, Bialystok, Poland
| | - Slawomir Dobrzycki
- Department of Invasive Cardiology, Medical University in Bialystok, Bialystok, Poland
| | - Bożena Sobkowicz
- Department of Cardiology, Medical University in Bialystok, Bialystok, Poland
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