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. 2021 Aug 25;13(16):20081-20093.
doi: 10.18632/aging.203476. Epub 2021 Aug 25.

Effect of diabetic kidney disease on therapeutic strategies for coronary artery disease: ten year follow-up

Daniel Valente Batista  1 , Whady Hueb  1 , Eduardo Gomes Lima  1 , Paulo Cury Rezende  1 , Cibele Larrosa Garzillo  1 , Rosa Maria Rahmi Garcia  1 , Jaime Paula Pessoa Linhares Filho  1 , Eduardo Bello Martins  1 , Carlos Vicente Serrano Junior  1 , Jose Antonio Franchini Ramires  1 , Roberto Kalil Filho  1
Affiliations

Effect of diabetic kidney disease on therapeutic strategies for coronary artery disease: ten year follow-up

Daniel Valente Batista et al. Aging (Albany NY). .

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.

Keywords: cardiac surgery; chronic renal failure; coronary artery disease; type 2 diabetes.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Study design. Flow-chart showing selection of patients. CABG, coronary artery bypass surgery; CAD: coronary artery disease; PCI: percutaneous coronary intervention.
Figure 2
Figure 2
Kaplan-Meier curves showing MACE (A), mortality (B), myocardial infarction (C), and additional revascularization (D), according to CKD status. eGFR, estimated glomerular filtration rate; MI, myocardial infarction.
Figure 3
Figure 3
Kaplan-Meier curves showing combined events (A, B) and death (C, D), according to CKD status and treatment group. CABG, coronary artery bypass surgery; eGFR, estimated glomerular filtration rate; MT, medical treatment; PCI, percutaneous coronary intervention.
Figure 4
Figure 4
Kaplan-Meier curves showing myocardial infarction (A, B) and additional revascularization (C, D), according to CKD status and treatment group. CABG, coronary artery bypass surgery; eGFR, estimated glomerular filtration rate; MI, myocardial infarction; MT, medical treatment; PCI, percutaneous.
See this image and copyright information in PMC

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