Estimated glomerular filtration rate as a predictor of secondary outcomes in Japanese patients with coronary artery disease

Abstract

Coronary artery disease (CAD) is highly prevalent and strongly associated with adverse outcomes in patients with chronic kidney disease (CKD). Recent data demonstrate that estimated glomerular filtration rate (eGFR) is more useful than serum creatinine as a predictor of outcomes. We investigated the clinical significance of eGFR-defined CKD in Japanese patients with CAD. In 702 consecutive patients with suspected CAD who underwent coronary angiography, CKD (eGFR <60 ml/min/1.73 m(2)) was present in 345 patients (49%). The eGFR value was lower in patients with multi-vessel coronary artery disease compared to patients with no significant stenosis (59+/-24 ml/min/1.73 m(2) vs 66+/-21 ml/min/1.73 m(2), p<0.01). During a follow-up period of 36 months, secondary events that included all-cause death and cardiovascular events requiring hospitalization occurred in 114 (16%) patients. Multivariate analysis using a Cox proportional hazards model showed that CKD [relative risk (RR) 1.707, 95%CI, 1.170-2.489; p=0.004] along with diabetes (RR, 1.684, 95%CI, 1.262-2.386; p=0.008) were independent predictors of secondary events. eGFR-defined CKD is an important predictor of secondary outcomes in Japanese patients with CAD. Anti-atherosclerotic therapies under eGFR monitoring to consider renoprotection would be an important strategy to improve long-term prognosis in Japanese CAD patients.