Abstract
Objective: Renal dysfunction represents a risk factor for poor coronary collateral growth. We investigated whether Glomerular Filtration Rate (GFR) estimated with the cystatin C-based formula (GFRCYS) is superior to that with the creatinine-based abbreviated Modification of Diet in Renal Disease (GFRMDRD) and the Chronic Kidney Disease Epidemiology Collaboration (GFREPI) equations for evaluating coronary collateralization in type 2 diabetic patients with stable coronary artery disease. Methods: GFR was estimated with creatinine- and cystatin C- based equations in 302 diabetic and 127 nondiabetic patients with stable angina and angiographic total occlusion of at least one major coronary artery. The degree of collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded as poor (Rentrop score of 0 or 1) or good collateralization (Rentrop score of 2 or 3). Results: In diabetic patients, GFRCYS correlated more closely with Rentrop score than GFRMDRD (Spearmen’s r=0.44 vs. Spearmen’s r=0.30, P=0.047) and GFREPI (Spearmen’s r=0.44 vs. Spearmen’s r=0.29, P=0.028), and area under the curve of GFRCYS was larger compared with that of GFRMDRD and GFREPI (0.78 vs. 0.68 and 0.66, P=0.001 and P<0.001) for predicting the presence of poor collateralization, along with a net reclassification improvement of 15.0% and 20.1% (P=0.025 and P=0.002). After adjusting for possible confounding variables, a GFR<90 mL/min/1.73m2 estimated with the cystatin C- based formula was more independently associated with poor collateralization (OR:6.21 vs. 2.86 and 2.36, P=0.042 and P=0.015). In contrast, GFRCYS, GFRMDRD, and GFREPI were similar for assessing coronary collateralization in non-diabetic patients. Conclusions: Cystatin C-based definition of renal dysfunction indicates a potential better clinical utility than creatinine-based equations for predicting poor Cystatin collaterals in diabetic atherosclerotic patients.
Highlights
Stroke is defined by focal neurological signs or symptoms thought to be of vascular origin that persisted for >24 h confirmed by brain CT and/or MRI in baseline conditions and brain CT with contrast medium after 48–72 hours and worldwide, it represents the second most common cause of mortality and the third most common cause of disability in developed countries
In the context of cerebrovascular disease, diabetes may contribute to a more insidious brain damage represented by the diseases of Small Cerebral Vessels (SVD) such as lacunae or White Matter Hyperintensity (WMH) increasing the risk of cognitive decline and dementia [7] suggesting that the relationship between impaired glucose metabolism and cerebrovascular disease is not limited to acute ischemic stroke
Among patients with diabetes several risk factors play a role together to promote the development of ischemic stroke
Summary
Stroke is defined by focal neurological signs or symptoms thought to be of vascular origin that persisted for >24 h confirmed by brain CT and/or MRI in baseline conditions and brain CT with contrast medium after 48–72 hours and worldwide, it represents the second most common cause of mortality and the third most common cause of disability in developed countries. In persons with a history of cardiovascular disease, it was 13.7 (95% confidence interval, 7.5 to 19.8) in men and 10.8 (95% confidence interval, 7.3 to 14.4) in women These results underline that the incidence rates of stroke that were observed in this study confirm the importance of this event in subjects with diabetes mellitus. Some authors [4], with the aim to quantify the associations of diabetes mellitus and fasting glucose concentration with risk of Coronary Heart Disease (CHD) and major stroke subtypes, have conducted a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from 102 prospective studies (including 530083 participants). In the context of cerebrovascular disease, diabetes may contribute to a more insidious brain damage represented by the diseases of Small Cerebral Vessels (SVD) such as lacunae or White Matter Hyperintensity (WMH) increasing the risk of cognitive decline and dementia [7] suggesting that the relationship between impaired glucose metabolism and cerebrovascular disease is not limited to acute ischemic stroke
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