Abstract 4844: Influence of Early Stage Chronic Kidney Disease on Coronary Spastic Angina

Abstract

Background: Chronic kidney disease (CKD) is associated with the morbidity and mortality of cardiovascular disease through atherosclerotic processes. However, the relationship between CKD and coronary artery spasm has not been elucidated. The aim of this study was to investigate whether CKD is associated with coronary spastic angina (CSA). Methods: We evaluated 127 patients (mean age 60 ± 12 years) who underwent coronary angiography with intracoronary acetylcholine or ergonovine provocation test. CSA was defined as total or subtotal coronary vasoconstriction with chest pain and ischemic ST segment changes on electrocardiography after provocation that were resolved by an intracoronary injection of isosorbide dinitrate, and the absence of organic coronary stenosis. Kidney function was determined by the estimated glomerular filtration rate (eGFR). Patients with eGFR ≤ 29 mL/min/1.73 m 2 were excluded. Results: There were 53 and 74 patients with and without CSA, respectively. Age and proportion of smokers, hypertension, diabetes mellitus, and obesity were similar between the two groups. The proportion of male gender and dyslipidemia was higher among the patients with, than without CSA (72 vs. 46 %, P = 0.004, and 49 vs. 31 %, P = 0.040). As compared with patients without CSA, patients with CSA had significantly lower eGFR value (70.4 ± 14.8 vs. 79.2 ± 17.2 mL/min/1.73 m 2 , P = 0.003) and higher proportion of eGFR category ≤ 59 mL/min/1.73 m 2 (25 vs. 11 %, P = 0.040). Prevalence of CSA was 56 % in the lowest eGFR quartile (< 63.9 mL/min/1.73 m 2 ) and 55% in second lower quartile (63.9 – 75.0 mL/min/1.73 m 2 ), which was significantly increased compared to 23 % in highest quartile (≥ 85.3 mL/min/1.73 m 2 ) (P = 0.006 and P = 0.009, respectively). No significant difference was observed between highest and second highest quartile (75.0 – 85.3 mL/min/1.73 m 2 ). Logistic regression analysis showed that independent factors associated with CSA were male gender (OR, 3.938; 95%CI, 1.725 to 8.988) and eGFR (OR, 0.658; 95%CI, 0.506 to 0.857). Conclusions: Mildly and moderately decreased eGFR is associated with a higher prevalence of CSA, suggesting that early stage CKD is related to a relatively initial stage of atherosclerosis. Management for CKD might lower the incidence of CSA.