The impact of normal range estimated glomerular filtration rate on mortality in selected patients undergoing coronary angiography – a long-term follow-up

Zornitzki, Lior; Sadon, Sapir; Wenkert, Atalia; Steinvil, Arie; Konigstein, Maayan; Ben-Shoshan, Jeremy; Bassat, Orit Kliuk‐Ben; Sirota, Svetlana; Halkin, Amir; Bazan, Samuel; Finkelstein, Ariel; Banai, Shmuel; Arbel, Yaron

doi:10.1097/mca.0000000000000985

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…As previously reported, a decrease in eGFR even within the normal or mildly reduced range is associated with increased mortality. 27 Hence, our assumption that increase in eGFR even within this normal range may be of clinical significance. In our cohort, patients with reduced baseline eGFR had a higher likelihood of a change in kidney function, either KFI or AKI.…”

Section: Discussionmentioning

confidence: 95%

Assessment of Kidney Function After Transcatheter Aortic Valve Replacement

Bassat

Sadon

Sirota

et al. 2021

Can J Kidney Health Dis

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Background: Transcatheter aortic valve replacement (TAVR), although associated with an increased risk for acute kidney injury (AKI), may also result in improvement in renal function. Objective: The aim of this study is to evaluate the magnitude of kidney function improvement (KFI) after TAVR and to assess its significance on long-term mortality. Design: This is a prospective single center study. Setting: The study was conducted in cardiology department, interventional unit, in a tertiary hospital. Patients: The cohort included 1321 patients who underwent TAVR. Measurements: Serum creatinine level was measured at baseline, before the procedure, and over the next 7 days or until discharge. Methods: Kidney function improvement was defined as the mirror image of AKI, a reduction in pre-procedural to post-procedural minimal creatinine of more than 0.3 mg/dL, or a ratio of post-procedural minimal creatinine to pre-procedural creatinine of less than 0.66, up to 7 days after the procedure. Patients were categorized and compared for clinical endpoints according to post-procedural renal function change into 3 groups: KFI, AKI, or preserved kidney function (PKF). The primary endpoint was long-term all-cause mortality. Results: The incidence of KFI was 5%. In 55 out of 66 patients patients, the improvement in kidney function was minor and of unclear clinical significance. Acute kidney injury occurred in 19.1%. Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 was a predictor of KFI after multivariable analysis (odds ratio = 0.93 to develop KFI; confidence interval [95% CI]: 0.91-0.95, P < .001). Patients in the KFI group had a higher Society of Thoracic Surgery (STS) score than other groups. Mortality rate did not differ between KFI group and PKF group (43.9% in KFI group and 33.8% in PKF group) but was significantly higher in the AKI group (60.7%, P < .001). Limitations: The following are the limitations: heterozygous definitions of KFI within different studies and a single center study. Although data were collected prospectively, analysis plan was defined after data collection. Conclusions: Improvement in kidney function following TAVR was not a common phenomenon in our cohort and did not reduce overall mortality rate.

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Section: Discussionmentioning

confidence: 95%

Assessment of Kidney Function After Transcatheter Aortic Valve Replacement

Bassat

Sadon

Sirota

et al. 2021

Can J Kidney Health Dis

Self Cite

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“…LV function is highly dependent on these functions and is usually represented by LV-EF, which has a known significant prognostic impact in several clinical scenarios [6]. Diabetic nephropathy is a clinical symptom with progressive decline in the GFR, which has a prognostic significance as well [7].…”

Section: Discussionmentioning

confidence: 99%

“…Left ventricular (LV) ejection fraction (EF) as a surrogate marker of LV systolic function is known to be a strong predictor of cardiovascular outcome and survival even in HF or following MI [6]. Similarly, renal function, as manifested by the glomerular filtration rate (GFR), has a graded inverse association with the burden of cardiovascular comorbidities and long-term adverse events [7]. Limited information is available, however, on the relationship of DM to the type of MI [ST-elevation (STEMI) vs. non-ST-elevation MI (NSTEMI)], to LV-EF, and to GFR, as well as on the clinical outcome in patients following percutaneous coronary interventions (PCIs) due to acute MI.…”

Section: Introductionmentioning

confidence: 99%

Survival of Myocardial Infarction Patients with Diabetes Mellitus at the Invasive Era (Results from the Városmajor Myocardial Infarction Registry)

Skoda

Nemes

Bárczi

et al. 2023

JCM

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Introduction. Due to the lifelong nature of diabetes mellitus (DM), it has been demonstrated to have significant effects on patients’ morbidity and mortality. The present study aimed to assess the effects of DM on the clinical outcome and survival in patients who underwent percutaneous coronary intervention (PCI) due to myocardial infarction (MI) and to examine the relationship of DM to the type of the MI and to left ventricular (LV) and renal functions. Methods. A total of 12,270 patients with ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) were revascularized at our Institution between 2005 and 2013. In this pool of patients, 4388 subjects had DM, while 7018 cases had no DM. Results. In both STEMI and NSTEMI, the 30-day and 1-year survival were worse in diabetic patients as compared to non-diabetic cases. In the patients with DM, NSTEMI showed worse prognosis within 1-year than STEMI similarly to non-diabetic subjects. Regarding survival, the presence of DM seemed to be more important than the type of MI. Regardless of the presence of DM, reduced LV function was a maleficent prognostic sign and DM significantly reduced the prognosis both in case of reduced and normal LV function. Survival is primarily affected by LV function, rather than DM. Worse renal function is associated with worse 30-day and 1-year survival in both cases with and without DM. Considering different renal functions, the presence of DM worsens both short- and long-term survival. Survival is primarily affected by renal function, rather than DM. Conclusions. The results from a high-volume PCI center confirm significant the negative prognostic impact of DM on survival in MI patients. DM is a more important prognostic factor than the type of the MI. However, survival is primarily affected by LV and renal functions, rather than DM. These results could highlight our attention on the importance of recent DM treatment with new drugs including SGLT-2 inhibitors and GLP-1 antagonists with beneficial effects on survival.

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The impact of normal range estimated glomerular filtration rate on mortality in selected patients undergoing coronary angiography – a long-term follow-up

Cited by 2 publications

References 23 publications

Assessment of Kidney Function After Transcatheter Aortic Valve Replacement

Assessment of Kidney Function After Transcatheter Aortic Valve Replacement

Survival of Myocardial Infarction Patients with Diabetes Mellitus at the Invasive Era (Results from the Városmajor Myocardial Infarction Registry)

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