Anna Tomaszuk-Kazberuk1, Dimitrios Nikas2, Paulina Lopatowska3, Elzbieta Młodawska3, Jolanta Malyszko4, Hanna Bachorzewska-Gajewska5,6, Slawomir Dobrzycki5, Bożena Sobkowicz3, Ioannis Goudevenos2. 1. Department of Cardiology, Medical University in Bialystok, Bialystok, Poland, a.tomaszuk@poczta.fm. 2. Cardiology Department, Ioannina University Hospital, Ioannina, Greece. 3. Department of Cardiology, Medical University in Bialystok, Bialystok, Poland. 4. Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland. 5. Department of Invasive Cardiology, Medical University in Bialystok, Bialystok, Poland. 6. Department of Clinical Medicine, Medical University in Bialystok, Bialystok, Poland.
Abstract
BACKGROUND/AIMS: Several studies have implicated atrial fibrillation (AF) as a contributing factor in chronic kidney disease (CKD) and cardiovascular events. The prevalence of coronary artery disease (CAD) in patients with AF varies substantially from 17% to 46.5%. There are only few studies concerning renal function in population with AF undergoing coronary angiography. The aim of the present study was to assess which type of AF is dominant in CKD population scheduled for coronary angiography and if it can influence patients' outcome, the association between renal impairment and the type of coronary procedures in AF patients and the influence of renal function on in-hospital mortality. METHODS: We retrospectively studied 867 patients with AF hospitalized due to coronary angiography in two year time. The cut off value of CKD was eGFR ≤ 60 ml/min./1.73m2 evaluated by CKD-EPI formula. RESULTS: A total of 867 patients with AF (44% women; mean age 72±10 years) were included in the analysis. The mean eGFR was 44±11ml/min./1.73m2 in patients with CKD and 89±18 ml/min./1.73m2 in patients with preserved renal function. Patients with CKD and AF were older (p< 0.001), had more often diabetes (p=0.009), heart failure (p< 0.001) and anaemia (p< 0.001). Patients with CKD and AF had more often permanent type of AF (p< 0.001). In CKD patients CHA2DS2VASc score was 4.3±1.5 and HAS-BLED score was 2.0±1.2 and it was significantly higher as compared to population with preserved renal function (p< 0.001, p=0.02, respectively). The use of oral anticoagulation was less frequent in CKD group (p< 0.001) although these patients had higher CHA2DS2VASc score. Patients with AF and CKD were more often admitted due to myocardial infarction (STEMI or NSTEMI) (p=0.02, p< 0.001, respectively) and more often underwent percutaneous coronary intervention (PCI) (p=0.01). Among coronary arteries the percutaneous coronary intervention (PCI) of left main artery was done more frequently in CKD patients (p=0.01). Among CKD population in-hospital mortality was significantly higher in patients with eGFR < 30 ml/min (p< 0.001). CONCLUSION: Patients with CKD had more often permanent type of AF. Percutaneous interventions of the left main coronary artery, the only elective procedures influencing patients' prognosis, were done more frequently in CKD patients with AF. In-hospital mortality was significantly higher in patients with severe renal impairment. Despite the higher risk of ischaemic stroke in CKD group the use of oral anticoagulation therapy was significantly less frequent and the patients were deprived of the confirmed benefits of such treatment.
BACKGROUND/AIMS: Several studies have implicated atrial fibrillation (AF) as a contributing factor in chronic kidney disease (CKD) and cardiovascular events. The prevalence of coronary artery disease (CAD) in patients with AF varies substantially from 17% to 46.5%. There are only few studies concerning renal function in population with AF undergoing coronary angiography. The aim of the present study was to assess which type of AF is dominant in CKD population scheduled for coronary angiography and if it can influence patients' outcome, the association between renal impairment and the type of coronary procedures in AFpatients and the influence of renal function on in-hospital mortality. METHODS: We retrospectively studied 867 patients with AF hospitalized due to coronary angiography in two year time. The cut off value of CKD was eGFR ≤ 60 ml/min./1.73m2 evaluated by CKD-EPI formula. RESULTS: A total of 867 patients with AF (44% women; mean age 72±10 years) were included in the analysis. The mean eGFR was 44±11ml/min./1.73m2 in patients with CKD and 89±18 ml/min./1.73m2 in patients with preserved renal function. Patients with CKD and AF were older (p< 0.001), had more often diabetes (p=0.009), heart failure (p< 0.001) and anaemia (p< 0.001). Patients with CKD and AF had more often permanent type of AF (p< 0.001). In CKDpatients CHA2DS2VASc score was 4.3±1.5 and HAS-BLED score was 2.0±1.2 and it was significantly higher as compared to population with preserved renal function (p< 0.001, p=0.02, respectively). The use of oral anticoagulation was less frequent in CKD group (p< 0.001) although these patients had higher CHA2DS2VASc score. Patients with AF and CKD were more often admitted due to myocardial infarction (STEMI or NSTEMI) (p=0.02, p< 0.001, respectively) and more often underwent percutaneous coronary intervention (PCI) (p=0.01). Among coronary arteries the percutaneous coronary intervention (PCI) of left main artery was done more frequently in CKDpatients (p=0.01). Among CKD population in-hospital mortality was significantly higher in patients with eGFR < 30 ml/min (p< 0.001). CONCLUSION:Patients with CKD had more often permanent type of AF. Percutaneous interventions of the left main coronary artery, the only elective procedures influencing patients' prognosis, were done more frequently in CKDpatients with AF. In-hospital mortality was significantly higher in patients with severe renal impairment. Despite the higher risk of ischaemic stroke in CKD group the use of oral anticoagulation therapy was significantly less frequent and the patients were deprived of the confirmed benefits of such treatment.
Authors: Katherine Mikovna Scovner; Simon Correa; Brian L Claggett; Conor D Barrett; Sushrut S Waikar; Scott D Solomon; Finnian R Mc Causland Journal: Am J Nephrol Date: 2021-05-05 Impact factor: 3.754
Authors: Beata Uziębło-Życzkowska; Paweł Krzesiński; Małgorzata Maciorowska; Iwona Gorczyca; Olga Jelonek; Maciej Wójcik; Robert Błaszczyk; Agnieszka Kapłon-Cieślicka; Monika Gawałko; Tomasz Tokarek; Renata Rajtar-Salwa; Jacek Bil; Michał Wojewódzki; Anna Szpotowicz; Małgorzata Krzciuk; Janusz Bednarski; Elwira Bakuła-Ostalska; Anna Tomaszuk-Kazberuk; Anna Szyszkowska; Marcin Wełnicki; Artur Mamcarz; Beata Wożakowska-Kapłon Journal: Cardiovasc Diagn Ther Date: 2021-02