Absence of Coronary Artery Disease is a Strong Negative Predictor of Major Adverse Cardiovascular Events in Patients with Chronic Kidney Disease.

Abstract

Purpose: To investigate the interplay between chronic kidney disease (CKD) and coronary artery disease (CAD) on the incidence of cardiovascular events in patients with suspected chronic coronary syndrome (CCS).

Patients and methods: Patients with suspected CCS who underwent first-time coronary angiography in Western Denmark between 2003 and 2016 were included in this cohort study. Moreover, an age- and sex-matched general population cohort was established. Patients were stratified according to estimated glomerular filtration rate (eGFR). Presence of CAD was defined as ≥1 obstructive stenosis or non-obstructive diffuse disease. Major adverse cardiovascular events (MACE) were defined as a composite of myocardial infarction, ischemic stroke, and cardiac death.

Results: A total of 42,611 patients were included with a median follow-up of 7.3 years. Patients without and with CAD had MACE rates per 100 person-years that were 0.52 and 1.67 for eGFR ≥90 mL/min/1.73 m², 0.68 and 2.09 for eGFR 60-89 mL/min/1.73 m², 1.27 and 3.85 for eGFR 30-59 mL/min/1.73 m², and 2.27 and 6.92 for eGFR <30 mL/min/1.73 m². Comparing to eGFR ≥90 mL/min/1.73 m², the adjusted incidence rate ratios for MACE were 1.29 (1.10-1.51) for eGFR 60-89 mL/min/1.73 m², 1.86 (1.49-2.33) for eGFR 30-59 mL/min/1.73 m², and 3.57 (1.92-6.67) for eGFR <30 mL/min/1.73 m² in patients without CAD, and 1.11 (1.03-1.20), 1.71 (1.55-1.90), and 2.46 (1.96-3.09) in patients with CAD. The inverse relationship between kidney function and risk of MACE was confirmed when comparing patients with and without CAD to matched individuals in the general population.

Conclusion: Absence of CAD is a strong negative predictor of major adverse cardiovascular events in patients with CKD.