J Korean Med Sci.  2015 Sep;30(9):1273-1278. 10.3346/jkms.2015.30.9.1273.

Prognostic Value of Renal Function for Cardiac Events in Patients Without Significant Stenosis on Coronary Computed Tomography Angiography

• Kim HL
• Kim YJ
• Yoon YE
• Lee SP
• Kim HK
• Cho GY
• Zo JH
• Choi DJ
• Sohn DW

• KMID: 2344152
• DOI: http://doi.org/10.3346/jkms.2015.30.9.1273

Abstract

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 +/- 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.

Keyword

Creatinine Clearance; Coronary Artery Disease; Multidetector Computed Tomography; Prognosis

MeSH Terms

Adult
Aged
Aged, 80 and over
Cardiovascular Diseases/diagnosis/*mortality
Comorbidity
Coronary Angiography/*statistics & numerical data
Coronary Stenosis/mortality/radiography
Female
Humans
Incidence
Kidney Diseases/*diagnosis/*mortality
Kidney Function Tests/*statistics & numerical data
Male
Middle Aged
Prognosis
Reproducibility of Results
Republic of Korea/epidemiology
Risk Assessment
Sensitivity and Specificity
Survival Rate
Tomography, X-Ray Computed/*statistics & numerical data

Figure

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  Fig. 1 Clinical outcome according to renal function.

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  Fig. 2 ROC curve analysis showing cut-off value of eCCr predicting cardiovascular events. ROC, receiver operating characteristic; eCCr, estimated creatinine clearance; AUC, area under curve; CI, confidence interval.

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  Fig. 3 Kaplan-Meier curve showing event free survival rates of clinical outcomes according to renal function. (A) Primary composite event rates and (B) hard event rates. CD, cardiac death; MI, myocardial infarction; UA, unstable angina; Revasc., revascularization; eCCr, estimated creatinine clearance.

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