Abstract
BackgroundCardiovascular morbidity and mortality are closely linked to chronic kidney disease (CKD). Sex-specific long-term outcome data of patients with coronary artery disease (CAD) and CKD are scarce.MethodsIn the prospective observational multicenter Coronary Artery Disease and REnal Failure (CAD-REF) Registry, 773 (23.1%) women and 2,579 (76.9%) men with angiographically documented CAD and different stages of CKD were consecutively enrolled and followed for up to 8 years. Long-term outcome was evaluated using survival analysis and multivariable Cox-regression models.ResultsAt enrollment, women were significantly older than men, and suffered from more comorbidities like CKD, hypertension, diabetes mellitus, and multivessel coronary disease. Regarding long-term mortality, no sex-specific differences were observed (Kaplan–Meier survival estimates: 69% in women vs. 69% in men, plog-rank = 0.7). Survival rates decreased from 89% for patients without CKD at enrollment to 72% for patients with CKD stages 1–2 at enrollment and 49% for patients with CKD stages 3–5 at enrollment (plog-rank < 0.001). Cox-regression analysis revealed that sex or multivessel coronary disease were no independent predictors of long-term mortality, while age, CKD stages 3–5, albumin/creatinine ratio, diabetes, valvular heart disease, peripheral artery disease, and left-ventricular ejection fraction were predictors of long-term mortality.ConclusionsSex differences in CAD patients mainly exist in the cardiovascular risk profile and the extent of CAD. Long-term mortality was not depended on sex or multivessel disease. More attention should be given to treatment of comorbidities such as CKD and peripheral artery disease being independent predictors of death.Clinical Trail Registration ClinicalTrials.gov Identifier: NCT00679419Graphic abstract
Highlights
Coronary artery disease (CAD) and chronic kidney disease (CKD) are frequently associated
Comparisons of sex and CKD stages within sex were done based on F tests and associated p values, using the Between January 2008 and May 2011, 773 (23.1%) women and 2,579 (76.9%) men with a ≥ 50% stenosis in at least one coronary artery were consecutively enrolled without preselection (Table 1)
Women were significantly older at time of enrollment (69.9 vs. 66.3 years, p < 0.001), had a lower estimated glomerular filtration rate (eGFR) (65.7 vs. 73.3 ml/min/1.73 m2, p < 0.001) and more often presented with severe CKD (39.1% vs. 26.9%), had a higher prevalence of hypertension (87.5% vs. 82.2%, p = 0.001), diabetes mellitus (28.8% vs. 24.6%, p = 0.02), and valvular heart disease (16.2% vs. 12.8%, p = 0.02), and a lower prevalence of prior myocardial infarction (26.5% vs. 34.3%, p < 0.001), previous coronary artery bypass grafting (CABG; 16.3% vs. 21.6%, p = 0.001) and percutaneous coronary intervention (PCI; 39.8% vs. 46.0%, p = 0.002)
Summary
Coronary artery disease (CAD) and chronic kidney disease (CKD) are frequently associated. Women have a higher prevalence of CKD than men [1], whereas the prevalence of CAD is higher in men than in women [2] Both morbidities share some risk factors, e.g., higher age, male sex, smoking, hypertension, and diabetes mellitus [2, 3], and patients with CKD are more likely to die from cardiovascular disease than to progress to end-stage renal disease [4]. Methods In the prospective observational multicenter Coronary Artery Disease and REnal Failure (CAD-REF) Registry, 773 (23.1%) women and 2,579 (76.9%) men with angiographically documented CAD and different stages of CKD were consecutively enrolled and followed for up to 8 years. Regarding long-term mortality, no sex-specific differences were observed (Kaplan–Meier survival estimates: 69% in women vs 69% in men, plog-rank = 0.7).
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