Patients with chronic kidney disease have a worse cardiovascular prognosis than those without. The aim of this study was to determine the incremental prognostic value of coronary computed tomographic angiography in predicting mortality across the entire spectrum of renal function in patients with known or suspected coronary artery disease (CAD). A large international multicenter registry was queried, and patients with left ventricular ejection fraction (LVEF) and creatinine data were screened. National Cholesterol Education Program Adult Treatment Panel III risk was calculated. Coronary computed tomographic angiographic results were evaluated for CAD severity (normal, nonobstructive, or obstructive) and an LVEF <50%. Patients were followed for the end point of all-cause mortality. Among 5,655 patients meeting the study criteria, follow-up was available for 5,572 (98.9%; median follow-up duration 18.6 months). All-cause mortality (66 deaths) significantly increased with every 10-unit decrease in renal function (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.07 to 1.41). All-cause mortality occurred in 0.33% of patients without coronary atherosclerosis, 1.82% of patients with nonobstructive CAD, and 2.43% of patients with obstructive CAD. Multivariate Cox proportional-hazards models revealed that impaired renal function (HR 2.29, 95% CI 1.65 to 3.18), CAD severity (HR 1.81, 95% CI 1.31 to 2.51), and an abnormal LVEF (HR 4.16, 95% CI 2.45 to 7.08) were independent predictors of all-cause mortality. In conclusion, coronary computed tomographic angiographic measures of CAD severity and the LVEF provide effective risk stratification across a wide spectrum of renal function. Furthermore, renal dysfunction, CAD severity, and the LVEF have additive value for predicting all-cause death in patients with suspected obstructive CAD.
Bibliographical noteFunding Information:
Dr. Achenbach receives grant support from Siemens Healthcare , Erlangen, Germany, and Bayer Schering Pharma AG , Berlin, Germany, and is a consultant for Servier, Neuilly-sur-Seine, France. Dr. Budoff is on the speaker's bureau of GE Healthcare. Dr. Cademartiri receives grant support from GE Healthcare , is a consultant for Servier, and is on the speaker's bureau of Bracco, Milan, Italy. Dr. Chinnaiyan receives grant support from Bayer Pharma AG and Blue Cross Blue Shield Blue Care Network of Michigan , Grand Rapids, Michigan. Dr. Kaufmann receives grant support from the Swiss National Science Foundation , Bern, Switzerland, and GE Healthcare. Dr. Maffei receives grant support from GE Healthcare . Dr. Raff receives grant support from Siemens Healthcare , Blue Cross Blue Shield Blue Care Network of Michigan , and Bayer Pharma AG . Dr. Min receives research support from and is on the speaker's bureau of GE Healthcare . Dr. Chow receives research support from GE Healthcare , Milwaukee, Wisconsin; Pfizer, Inc. , New York, New York; and AstraZeneca , Wilmington, Delaware. Dr. Chow receives fellowship support from GE Healthcare and educational support from TeraRecon Inc , Foster City, California.
Dr. Dwivedi is supported by the Dowager Countess Eleanor Peel Trust (Peel and Rothwell Jackson Postgraduate Travelling Fellowship), London, United Kingdom; the Whit & Heather Tucker Endowed Research Fellowship in Cardiology , Ottawa, Ontario, Canada; and the Banting Postdoctoral Fellowship , Ottawa, Ontario, Canada. Dr. Kaufman is supported by the Swiss National Science Foundation , Bern, Switzerland. Dr. Chow is supported by New Investigator Award MSH-83718 from the Canadian Institutes of Health Research , Ottawa, Ontario, Canada.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine