CKD and Coronary Collateral Supply in Individuals Undergoing Coronary Angiography after Myocardial Infarction

Abstract

SummaryBackground and objectives CKD patients have high mortality risk after myocardial infarction (MI). An adequate supply of coronary collaterals to the culprit vessel responsible for MI is associated with reduced risks of death and complications. Whether a diminished supply of collaterals contributes to the high risk in CKD patients is uncertain.Design, setting, participants, & measurements Quantitative coronary angiography was performed in a consecutive series of individuals with (n=58) and without (n=165) CKD (estimated GFR ,60 ml/min per 1.73 m 2 ) who underwent coronary angiography at the time of MI. Collateral supply was analyzed and candidate predictors were assessed in patient-level and individual artery-level models using logistic regression and ordered categorical regression, respectively.Results There were no significant differences in collateral supply among 58 CKD patients and 165 individuals with preserved renal function. Culprit artery collaterals were present in 25.0% of CKD patients compared with 27.2% of individuals with preserved renal function (P=0.76). The odds of having an adequate supply of culprit vessel collaterals were also not significantly different in individuals with and without CKD, respectively. CKD patients were 2.22-fold more likely to have visible collaterals to the nonculprit vessels in unadjusted analyses. The difference was not significant after correction for percent stenosis and comorbid factors.Conclusions Our results do not support an independent association between CKD and diminished collateral supply to either the culprit or nonculprit vessels in MI. Additional studies are warranted to better define associations between myocardial capillary supply, collateral supply, and the full range of human CKD.

Coronary Collateral Circulation and Cardiovascular Risk Factors

“…10 On the other hand, Charytan et al, who compared 58 patients with impaired renal function with 165 patients with preserved renal function, found that there was no association between renal impairment and coronary CC. 36 Our study not only demonstrated a significant difference in CCs among patients with graded impairment in renal function but also showed that this impairment was significant below a specific eGFR. Our findings showed that patients with eGFR <60 mL/min/1.73 m 2 were less likely to have CCs than patients with eGFR >60 mL/min/1.73 m 2 .…”

“…Although renal impairment has long been associated with higher risk of cardiovascular events such as MI or post-MI complications, 32 it is not well known whether this stems from its effect on the CC circulation. Animal models have shown that uremia is associated with impaired ischemia-induced angiogenesis and reduced myocardial capillary density.…”

“…10 On the other hand, Charytan et al, who compared 58 patients with impaired renal function with 165 patients with preserved renal function, found that there was no association between renal impairment and coronary CC. 36…”

An Update on Coronary Artery Disease and Chronic Kidney Disease

“…Charytan et al hypothesized that CKD patients might have less collateral blood supply to ischemic area of the myocardium and this hypothesis might partially explain why CKD patients have much worse CV outcomes and death. However, this study failed to prove this hypothesis because both CKD patients and subjects without CKD had similar culprit artery collateral supply (25% versus 27.2%, resp., P = 0.76) [ 25 ].…”

Coronary heart disease and chronic kidney disease: the possibilities of PCSK9 inhibitors in the achievement of atherogenic lipoproteins target values

“…При хронической болезни почек (ХБП) нередко определяется микроваскулярная дисфункция, приводящая к ишемии миокарда [5,6]. У пациентов со сниженной почечной функцией, атеросклеротическая бляшка более насыщена липидами и менее насыщена соединительной тканью, что значимо увеличивает ее ранимость [7]. В связи с этим ХБП сопровождается более тяжелым коронарным атеросклерозом [8,9].…”