Author + information
- Paul Kalra,
- Xavier García-Moll,
- Jose Zamorano,
- Kim Michael Fox,
- Ian Ford,
- Roberto Ferrari,
- Jean Claude Tardif,
- Michal Tendera,
- Nicola Greenlaw,
- Philippe Steg,
- for the CLARIFY Investigators
Historic data suggest that patients with chronic kidney disease (CKD) receive suboptimal secondary prevention following myocardial infarction. We assessed the frequency of CKD in patients with stable coronary artery disease (CAD) and its impact on medical therapy in a contemporary global study.
Estimated glomerular filtration rate (eGFR, CKD-EPI) was available for 22,560 patients recruited to the Prospettive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY) study. Patients were grouped and evaluated according to eGFR (CKD stage).
22% had eGFR<60ml/min/1.732. Declining renal function was associated with gender, age, higher prevalence of co-morbidities (not all shown), pulse pressure and lower hemoglobin. There were no clinically meaningful differences in heart rate or lipid profile. Patients with CKD were more likely to have undergone CABG but less likely PCI. High use of secondary prevention was seen across all CKD stages (overall 93% for statins). ACE inhibitor use was lower and related to eGFR. Anticoagulation for history of AF was underutilized across all CKD stages (overall 44%).
CKD is common in patients with CAD and associated with age, co-morbidity and vascular stiffness. Secondary prevention was generally very good. ACE inhibitors were used less in advancing CKD; surprisingly the reverse was seen for ARBs.
|eGFR (ml/min/1.73m2)||<45 (n=1570)||45–59 (n=3443)||60–89 (n=11958)||90 or > (n=5589)||P value|
|Age yrs (SD)||71.5 (9.5)||69.7 (8.8)||64.7 (9.5)||56.5 (8.8)||<0.0001|
|Male gender (%)||63||67||79||84||<0.0001|
|Never smoked (%)||50||49||41||36||<0.0001|
|Treated hypertension (%)||84||78||71||65||<0.0001|
|History of diabetes (%)||45||34||28||30||<0.0001|
|Systolic BP mmHg (SD)||133 (18)||133 (18)||131 (17)||129 (16)||<0.0001|
|ACE inhibitor (%)||43||50||52||54||<0.0001|
|Angiotensin receptor blocker (%)||37||32||26||22||<0.0001|
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Rock and a Hard Place: Chronic Kidney Disease and the Heart
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1193-60
- 2013 American College of Cardiology Foundation