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J Thorac Cardiovasc Surg 2009;137:1443-1449
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Mild chronic kidney dysfunction and treatment strategies for stable coronary artery disease

Neuza Helena Lopes, MD, PhD*, Felipe da Silva Paulitsch, MD, Alexandre Pereira, MD, PhD, Cibele Larossa Garzillo, MD, João Fernando Ferreira, MD, PhD, Noedir Stolf, MD, PhD, Whady Hueb, MD, PhD

Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

Received for publication July 24, 2008; revisions received October 21, 2008; accepted for publication November 19, 2008.

* Address for reprints: Neuza Helena Lopes, MD, PhD, Av D. Enéas de Carvalho Aguiar # 44, sala 114. Cerqueira Cesar, São Paulo-SP/ Brazil 05403-000. (Email: mass{at}incor.usp.br).

Objective: Our objective was to evaluate the association of chronic kidney dysfunction in patients with multivessel chronic coronary artery disease, preserved left ventricular function, and the possible interaction between received treatment and cardiovascular events.

Methods: The glomerular filtration rate was determined at baseline on 611 patients who were randomized into three treatment groups: medical treatment, percutaneous coronary intervention, and coronary artery bypass surgery. Incidence of myocardial infarction, angina requiring a new revascularization procedure, and death were analyzed during 5 years in each group.

Results: Of 611 patients, 112 (18%) were classified as having normal renal function, 349 (57%) were classified as having mild dysfunction, and 150 (25%) were classified as having moderate dysfunction. There were significant differences among the cumulative overall mortality curves among the three renal function groups. Death was observed more frequently in the moderate dysfunction group than the other two groups (P < .001). Interestingly, in patients with mild chronic kidney dysfunction, we observed that coronary artery bypass treatment presented a statistically higher percentage of event-free survival and lower percentage of mortality than did percutaneous coronary intervention or medical treatment

Conclusions: Our results confirm that coronary artery disease accompanied by chronic kidney dysfunction has a worse prognosis, regardless of the therapeutic strategy for coronary artery disease, when renal function is at least mildly impaired. Additionally, our data suggest that the different treatment strategies available for stable coronary artery disease may have differential beneficial effects according to the range of glomerular filtration rate strata.

Abbreviations and Acronyms APPROACH = Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease; CABG = coronary artery bypass grafting; CAD = coronary artery disease; CI = confidence interval; CKD = chronic kidney dysfunction; eGFR = estimated glomerular filtration rate; HDL = high-density lipoprotein; MASS II = Medicine, Angioplasty, or Surgery Study; MDRD = Modification of Diet in Renal Disease; MI = myocardial infarction; MT = medical treatment; NKF = National Kidney Foundation; PCI = percutaneous coronary intervention; PRESTO = Results of Prevention of REStenosis with Tranilast and its Outcomes; RF = renal function; RR = relative risk






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