Research Paper Volume 13, Issue 16 pp 20081—20093
Effect of diabetic kidney disease on therapeutic strategies for coronary artery disease: ten year follow-up
- 1 Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
Received: May 9, 2021 Accepted: August 16, 2021 Published: August 25, 2021
https://doi.org/10.18632/aging.203476How to Cite
Copyright: © 2021 Batista et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: The best treatment for coronary artery disease (CAD) in patients with type 2 diabetes (DM2) and chronic kidney disease is unknown.
Methods: This retrospective study included MASS registry patients with DM2 and multivessel CAD, stratified by kidney function. Primary endpoint was combined of mortality, myocardial infarction, or additional revascularization.
Results: Median follow-up was 9.5 years. Primary endpoint occurrences among strata 1 and 2 were 53.4% and 40.7%, respectively (P=.020). Mortality rates were 37.4% and 24.6% in strata 1 and 2, respectively (P<.001). We observed a lower rate of major adverse cardiovascular events (MACE) (P=.027 for stratum 1 and P<.001 for stratum 2) and additional revascularization (P=.001 for stratum 1 and P<.001 for stratum 2) for those in the surgical group. In a multivariate analysis, eGFR was an independent predictor of MACE (P=.034) and mortality (P=.020).
Conclusions: Among subjects with DM2 and CAD the presence of lower eGFR rate was associated with higher rates of MACE and mortality, irrespective of treatment choice. CABG was associated with lower rates of MACE in both renal function strata. eGFR was an independent predictor of MACE and mortality in a 10-year follow-up.
Abbreviations
AMI: Acute myocardial infarction; BMS: Bare metal stents; CABG: Coronary artery bypass graft; CAD: Coronary artery disease; CKD: Chronic kidney disease; DES: Drug eluting stents; eGFR: Estimated glomerular filtration rate; MASS: Medicine, Angioplasty, or Surgery Study; MT: Medical treatment; PCI: Percutaneous coronary intervention.