Coronary physiology, FFR and iFR, has been shown safe to defer lesions and effective to save stents by different randomized studies and registries. However, patients with chronic kidney disease have not been thoroughly analyzed yet, which brings us to the question about what to do in the face of their negative evolution, when atherosclerosis develops faster, and stress tests are required before we would normally expect.
This is a retrospective study including 439 patients. 319 (72.7%) presented conserved kidney function assessed with glomerular filtration (eGFR > 60 mL/min/1.73 m2,), and 120 showed evidence of chronic kidney disease (CKD) (glomerular filtration eGFR < 60 mL/min/1.73 m2).
251 patients with conserved kidney function were deferred with FFR (78,7%) and 78 with iFR (21,3%), while 94 CKD patients were deferred with FFR (78,3%) and 26 with iFR (21,7%).
Primary end point was a composite of all cause death, MI or unplanned revascularization. Secondary end point was all cause death, cardiac death, MI and unplanned revascularization.
Patients with CKD were older, and presented more hypertension, diabetes, peripheral vascular disease and use of anticoagulation, but lower use of ASA.
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There were no differences in number of interrogated lesions or their location. The left anterior descending artery was the most involved.
FFR was used 80% of times.
After 4 years, primary end point was higher in patients with CKD (25% vs. 14% p=0.01). Also, all-cause mortality (13.3% vs. 5.3%, p=0.006) and cardiovascular mortality (5.8% vs. 1.3% p=0.01) were higher. Unplanned revascularization was also higher, though not significantly. There were no differences in MI or target vessel related MI.
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Patients with 4 or 5 stage CKD presented more events vs. patients with conserved kidney function.
Evolution was analyzed according to lesion assessment strategy and there were no differences between FFR and iFR.
Conclusion
Patients with CKD and deferred coronary lesions after pressure-wire evaluation develop more events in the long term compared against patients presenting conserved kidney function. However, this increased number of events in CDK patients was rarely related to the deferred vessel, which suggests an epiphenomenon of intrinsically higher cardiovascular risk in CKD patients.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Reference: Alejandro Travieso, et al. Cardiol J 2022, 29, 4: 553–562.
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