Renal function and short-term outcome in stable outpatients with coronary, cerebrovascular or peripheral artery disease

- CAD patients with renal insufficiency have a higher risk of myocardial infarction.
- CAD patients should be warned for requesting help in case of symptoms suggesting MI.
- These findings were not observed in patients with CVD or PAD.

BackgroundThe influence of renal function on outcome in stable outpatients with atherosclerotic disease has not been thoroughly studied.MethodsWe used the FRENA Registry data to compare the incidence of subsequent ischemic events (myocardial infarction [MI], ischemic stroke or limb amputation) in patients with coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD), according to their estimated glomerular filtration rate (eGFR) at baseline.ResultsAs of April 2012, 3860 patients were recruited in FRENA: 1439 with CAD, 1118 with CVD and 1303 with PAD. Over a mean follow-up of 14 ± 12 months, 97 patients suffered subsequent MI, 93 had ischemic stroke and 46 underwent limb amputation. In all, 2699 patients (70%) had eGFR > 60 mL/min/1.73 m2, 1022 (26%) had 30-60 mL/min/1.73 m2, and 139 (3.6%) had <30 mL/min/1.73 m2. Among patients with CAD, the rate of subsequent MI was: 1.38 (95% CI: 0.85-2.11), 5.79 (95% CI: 3.90-8.31) and 18.8 (95% CI: 9.14-34.4) events per 100 patient-years, respectively. On multivariable analysis, the hazard ratio for MI (compared with patients with eGFR > 60 mL/min/1.73 m2) was of 1.77 (95% CI: 1.15-2.73) for patients with eGFR of 30-60 mL/min/1.73 m2, and 3.15 (95% CI: 1.61-6.14) for those with eGFR < 30 mL/min/1.73 m2. Among patients with CVD or PAD, there was no increasing rate of subsequent ischemic events with decreasing renal function.ConclusionsAmong stable outpatients with CAD, there is an increasing rate of subsequent MI with decreasing renal function, independently of potentially confounding variables. These findings were not observed in patients with CVD or PAD.