Impact Of Glomerular Filtration Rate On Coronary Collateralcirculation And Its Outcome In CAD Patients With Normal Serum Creatinine

Objective: To explore the Impact of Glomerular Filtration Rate(GFR) on Coronary Collateral Circulation(CCC) And its outcome in coronary artery disease(CAD) Patients With Normal Serum Creatinine. Methods: A total of 194 CAD patients with coronary stenosis≥95% having normal serum creatinine treated in our hospital from 2013-05 to 2014-04 were studied. According to the Rentrop scoring system, the patients were divided into 2 groups: Poor CCC group, the patients with Rentrop score at 0-1, n =113 and Sufficient CCC group, the patients with Rentrop score at 2-3, n =81. The clinical information such as age, gender, past history, serum creatinine level, fasting glucose and lipid were recorded at admission. The abbreviated modification of diet in renal disease(MDRD) study equation was used to estimate e GFR. The relationship between Poor CCC occurrence and e GFR was evaluated by multivariate Logistic regression analysis.Major adverse cardiovascular events(MACE) was recorder during(8.31±6.02)months follow up, at last patients were divided into three groups based on the e GFR and used Kaplan Meier survival curve to analysis. Results: Within the normal range of serum creatinine, compared with Sufficient CCC group, the patients in Poor CCC group had decreased e GFR level(78.7 ± 20.5) ml/(min·1.73m-2) vs(89.6 ± 3.2) ml/(min·1.73m-2), P =0.012, increased fasting glucose level(7.5 ± 3.4) mmol/L vs(6.7 ± 2.8) mmol/L, P =0.003 and hs-CRP(2.7 ± 0.8) mg/ L vs(2.3 ± 0.6) mg/L, P =0.029; Poor CCC group had the lower Rentrop score,(7.7 ± 3.9) vs(9.1 ± 5.0), P =0.004. Multivariate logistic regression analysis presented that e GFR(OR=0.19, 95% CI 0.14-0.22, P =0.027), hs-CRP(OR=1.58, 95% CI 1.24-2.44, P =0.028), Rentrop score(OR=0.98, 95% CI 0.97-0.99, P <0.001) and fasting glucose(OR=1.21, 95% CI 1.06-1.41,P =0.002) were the independent risk factors for poor CCC occurrence.Patients with MACE had lower levels of e GFR[(73.5±18.6) vs(88.4±22.7), P = 0.017)],higher levels of hs-CRP [(3.1±0.9) vs(2.6±0.9), P = 0.012) and uric acid level [(350.7±96.5) vs(324.0±90.1), P = 0.019] compared with patients without MACE. Kaplan Meier survival curve showed that within the normal range of serum creatinine,as the e GFR reducing,the incidence of MACE suggested a significant upward trend. Conclusion: e GFR level is the important predictor of poor CCC occurrence in CAD patients with normal serum level of creatinine and could effectively predict the poor prognosis in the future.