Polyvascular disease in patients with myocardial infarction and chronic kidney disease


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Abstract

Aim. To study polyvascular disease in patients with myocardial infarction (MI) and chronic kidney disease (CKD). Materials and methods. A total of 954 patients older than 18 years old with ST-segment elevation MI (STEMI) up to 24 hours of pain onset were included in the study. Clinical and demographic data were collected for all patients, including physical examination, 16-lead electrocardiogram recording, echocardiography, laboratory assessment with the measurements of cardiospecific enzymes and serum creatinine. Glomerular filtration rate (GFR) was estimated according to the CKD-EPI equation. Of them, 771 (81%) underwent coronary angiography, duplex scanning of the brachiocephalic (BCA) and lower extremity arteries (LEA). Patients with stage 1-4 CKD diagnosed according to the criteria provided by the Russian Society of Nephrologists were allocated into a separate group (n=281; 36.5%). CKD stages were determined with the level of GFR. Patients with stage 5 CKD were excluded from the study. Renal dysfunction was defined as the presence of an estimated GFR less than 60 ml/min/1.73 m2. Results and discussion. The results of the study indicate a high prevalence of PolyVD in patients with CKD. Every second patient had LEA stenosis (p<0.001), and every fifth patient had multiple arterial bed lesions (≥3 arterial beds; p=0.018), multiple coronary artery disease (p<0.001), independently from kidney function. Patients with stage 1 and 2 CKD commonly had hemodynamically insignificant arterial stenoses (<30%; p=0.036), whereas stage 3 and 4 CKD patients had significant stenotic lesions (p<0.05). Patients with stage 3 and 4 CKD more frequently suffered from three and more arterial bed lesions (p=0.030). Logistic regression reported that renal dysfunction (stage 3 CKD and above) was considered as an independent predictor of PolyVD. Conclusion. CKD is associated with highly prevalent and severe PolyVD. The severity of PolyVD is directly related to the stage of renal dysfunction (CKD stage).

About the authors

V. N Karetnikova

Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University

д.м.н., проф., зав. лаб. патологии кровообращения ФГБНУ «НИИ КПССЗ», проф. каф. кардиологии и сердечно-сосудистой хирургии ФГБОУ ВО «КемГМУ» Kemerovo, Russia

V. V Kalaeva

Research Institute for Complex Issues of Cardiovascular Diseases

Email: kalavv@kemcardio.ru
врач-кардиолог ФГБНУ «НИИ КПССЗ» Kemerovo, Russia

M. V Evseeva

Research Institute for Complex Issues of Cardiovascular Diseases

н.с. лаб. патологии кровообращения ФГБНУ «НИИ КПССЗ» Kemerovo, Russia

O. V Gruzdeva

Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University

д.м.н., зав. лаб. исследования гомеостаза ФГБНУ «НИИ КПССЗ», доц. каф. биомедицинской химии ФГБОУ ВО «КемГМУ» Kemerovo, Russia

M. V Zykov

Research Institute for Complex Issues of Cardiovascular Diseases

в.н.с. лаб. патофизиологии мультифокального атеросклероза ФГБНУ «НИИ КПССЗ» Kemerovo, Russia

V. V Kashtalap

Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University

д.м.н., доц. каф. кардиологии и сердечно-сосудистой хирургии ФГБОУ ВО «КемГМУ», зав. лаб. патофизиологии мультифокального атеросклероза ФГБНУ «НИИ КПССЗ» Kemerovo, Russia

O. L Barbarash

Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University

член-корр. РАН, д.м.н., проф., зав. каф. кардиологии и сердечно-сосудистой хирургии ФГБОУ ВО «КемГМУ», директор ФГБНУ «НИИ КПССЗ» Kemerovo, Russia

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