Analysis Of The Effects Of Occult Renal Dysfunction On Coronary Artery Lesions And Prognosis

ObjectiveThe effects of chronic kidney disease on coronary artery lesions has been demonstrated,but there aren’t enough evidences to prove the effects of occult renal dysfunction on coronaryartery lesions and clinical prognosis.This study uses formula to get the eGFR on basis ofserum Cr and CysC,and analysis its effect on coronary artery lesions and clinical prognosis inand after revascularization therapy.Methods258patients who had undergone coronary angiography in our department with normalserum Cr and CysC levels were enrolled in our study from August2012to August2013.Patients who had been diagnosed with heart,pulmonary.hepatic,renal failure oracute/chronic infection,were excluded.Patients with valvular heart disease or congenital heartdefect and those who had underwent revaseularization therapy were exeluded.The GFR wasestimated using the CKD-EPI formula;the presence of gender,age,history of smoking,hypertension, diabetes mellitus, bood fat, blood glucose, C reactive protein, diameter of leftatrium, left ventricular ejection fraction et al. were recorded.Using the coronary lesions score and stenosis score to evaluate the lesions of coronaryartery based on angiography.Lesions that involving the opening of the main arteries and leftmain artery, cornary calcification, chronic occlusion etc. were recorded.Using the Rentrop andCohen grade and Werner CC grade to evaluate the formation and function of collateralcirculation. Using the TIMI grade to evaluate the condition of blood flow duringrevascularization therapy.A6months follow-up were conducted with all patients to evaluatethe main adverse cardiovasular events.All subjects were divided into2groups according to eGFR levels, those whoseeGFRwere≥90ml/min/1.73m2were divided into normal renal function group, and theopposite were divided into the occult renal dysfunction group.Baseline data were comparedbetween the2groups; analysis the relationship between eGFR and features of coronarylesions,blood flow during revascularization therapy; compare the average length of hospital stay and6-months major adverse cardiovascular events between the two groups.ResultsThe difference between the2groups of red blood cell count (4.68±0.49vs.4.48±0.75,P=0.014) and hemoglobin (143.79±12.98vs.139.20±20.90, P=0.043) are statisticallysignificant. Coronary lesions score(1.98±0.85vs.1.41±1.06, P=0.001) and stenosis score(45.50±19.07vs.31.38±12.17, P=0.002) in occult renal dysfunction group are significantlyhigher than that of the normal renal function group.eGFR have a significantly negativecorrelation with coronary artery lesions (r=0.303, P<0.001) and the degree of stenosis(r=0.237, P<0.001).Binary logistic regression model suggests occult renal insufficiency is anindependent risk factor for three-vessle lesions (odds ratio=2.228, standard error=0.304,95%CI=0.812-0.931, P=0.008).Chronic occlusion lesions in occult renal insufficiency groupis signifcantly higher than that of normal renal function group (P=0.018),and the incidence ofslow blood flow and no reflow conditions during revascularization therapy are significantlyhigher than those of the normal renal function group (P<0.001).Incidence of postoperativeangina pectoris and heart failure in the occult renal dysfunction group increases significantlyin6months follow-up (both P<0.05).ConclusionsOccult renal insufficiency has an adverse impact on lesions of coronary artery, and eGFRhas an significantly negative correlation with the severity of coronary lesions.Occult renaldysfunction has a negative effects on the condition of blood flow during revascularizationtherapy and the incidence of postoperative cardiovascular events.