P6475Impact of chronic kidney dysfunction among patients with stable coronary artery disease: ten-year follow-up of mass II trial

Abstract

Introduction: Chronic kidney disease (CKD) has poor prognosis among patients with stable coronary artery disease (CAD), but there is a lack of evidence regarding long term follow‐up. Purpose: Our objective was to evaluate the CKD in patients with multivessel CAD preserved ventricular function, and the interaction between received treatment and mortality in a 10‐year follow‐up. Methods: The glomerular filtration rate was determined at baseline on 611 patients who were randomized into three treatment groups: medical treatment (MT), percutaneous coronary intervention (PCI), and coronary artery bypass surgery (CABG). Endpoint considered was overall death. Survival was estimated by the Kaplan‐Meier method and hazard ratio (HR) using Cox proportional hazard. Results: Of 611 patients, 112 (18%) had normal renal function, 349 (57%) mild dysfunction, and 150 (25%) moderate dysfunction. Treatment assigned and baseline characteristics were similar among renal function (RF) groups, except by age, smoking, body mass index, number of diseased vessels, triglycerides, and HDL cholesterol levels. There were significant differences among cumulative overall mortality curves among the three renal function groups. Survival rates were 81.3%, 76,2% and 60,7% for normal renal function, mild CKD, and moderate CKD respectively (log‐rank=0.001; HR: 0.43: 0.26‐0.70 for normal RF versus moderate CKD; and HR: 0.64; 0.46‐0.90 for mild versus moderate CKD). Comparing treatment strategies in RF groups we observed a higher survival in CABG group (81%) compared to those in PCI (75.9%) and MT (71.4%) groups among mild CKD subjects (log‐rank:0.015; HR: 0.44; 0.25‐0.77 for CABG versus MT; HR: 0.59; 0.33‐1.03 for CABG versus PCI) Conclusions: CAD associated to chronic kidney dysfunction has a worse prognosis, regardless of the therapeutic strategy option. Additionally, our data suggest that CABG is related to higher survival when compared to MT among mild CKD subjects.