Renin‐angiotensin‐aldosterone System Inhibitors and Major Cardiovascular Events and Acute Kidney Injury in Patients with Coronary Artery Disease

Background: Left ventricular dysfunction (LVD), followed by fall in cardiac output is one of the major complications in some coronary artery disease (CAD) patients. The decreased cardiac output over time leads to activation of the renin-angiotensin-aldosterone system which results in vasoconstriction by influencing salt-water homeostasis. Therefore, the purpose of the present study was to explore the association of single nucleotide polymorphisms (SNPs) in angiotensin I converting enzyme;ACE(rs4340), angiotensin II type1 receptor; AT1 (rs5186) and aldosterone synthase;CYP11B2(rs1799998) with LVD.Methods and results: The present study was carried out in two cohorts. The primary cohort included 308 consecutive patients with angiographically confirmed CAD and 234 healthy controls. Among CAD, 94 with compromised left ventricle ejection fraction (LVEF ≤ 45) were categorized as LVD. The ACE I/D, AT1 A1166C andCYP11B2T-344C polymorphisms were determined by PCR. Our results showed that ACE I/D was significantly associated with CAD but not with LVD. However, AT1 1166C variant was significantly associated with LVD (LVEF ≤ 45) (p value=0.013; OR=3.69), butCYP11B2(rs1799998) was not associated with either CAD or LVD. To validate our results, we performed a replication study in additional 200 cases with similar clinical characteristics and results again confirmed consistent findings (p value=0.020; OR=5.20).Conclusion: AT1 A1166C plays important role in conferring susceptibility of LVD.

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Anemia as a risk factor of contrast-associated acute kidney injury

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.12.200450 ◽

2020 ◽

Vol 92 (12) ◽

pp. 48-52

Author(s):

O. Iu. Mironova ◽

A. D. Deev ◽

P. G. Lakotka ◽

V. V. Fomin

Keyword(s):

Coronary Artery Disease ◽

Acute Kidney Injury ◽

Risk Factor ◽

Coronary Artery ◽

Serum Creatinine ◽

Statistical Significance ◽

Kidney Injury ◽

Chronic Coronary Artery Disease ◽

Absolute Increase ◽

Artery Disease

Aim.The aim of our study was to assess the role of anemia as a risk factor of contrast-associated acute kidney injury (CA-AKI) in patients with stable coronary artery disease. Materials and methods.1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). 83 patients had anemia. CA-AKI was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The primary endpoint of the study was the development of CA-AKI according to KDIGO criteria. Results.CA-AKI developed in 12 (14.5%) patients with anemia according to the relative increase of the level of serum creatinine (25% and more from the baseline). With using the absolute increase of the level of serum creatinine the prevalence of CA-AKI was 2 (2.4%) patients. Patients with anemia had higher rate of CA-AKI than the overall population of the study (14.4% versus 12.7%). Although our results were not statistically significant (р=0.61, odds ratio 1.19, 95% confidence interval 0.632.24). Conclusion.The prevalence of CA-AKI was higher in the group of patients with anemia, but didnt meet statistical significance and needs further evaluation in larger studies.

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Perioperative evaluation of kidney function for patients with complicated forms of coronary artery disease

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.4(68).2020.08 ◽

2020 ◽

pp. 52-58

Author(s):

O. Gogayeva ◽

V. Lazoryshynets ◽

A. Rudenko ◽

L. Dzakhoieva ◽

O. Yuvchyk

Keyword(s):

Coronary Artery Disease ◽

Acute Kidney Injury ◽

Coronary Artery ◽

Kidney Function ◽

Postoperative Period ◽

Kidney Injury ◽

Perioperative Period ◽

Early Postoperative Period ◽

Chronic Obstructive ◽

Artery Disease

The study aimed to analyze kidney function for patients with complicated forms of coronary artery disease (CAD) in the perioperative period. Methods. It was a retrospective analysis of 110 high-risk patients with complicated forms of CAD, who were operated on and discharged from the National M. Amosov Institute for the period from 2009 till 2019 years. Kidney function was evaluated by glomerular filtration rate (GFR), calculated online with СKD-EPI formula. Results. Among the included patients there were 86 (78.1%) patients with metabolic syndrome, 81 (73.59%) patients with disorders of glucose metabolism, 82 (74.5%) subjects with chronic obstructive pulmonary disease and 38 (34.5%) patients had chronic kidney disease (CKD) 3-5 stage. Preoperative risk stratification with EuroScore II scale was 9.4%. All operations performed in cardiopulmonary bypass; Custodial cardioplegia was used in 53 (48.1%) patients. The average perfusion time was 111 minutes, average cross-clamping time was 73.9 minutes. Acute kidney injury in the early postoperative period had 9 (8.1%) patients. Conclusions. At the admittance 38 (34.5%) patients with complicated forms of CAD had CKD 3-5 st. Analysis of the GFR dynamic in the early postoperative period shown a decrease in GFR in 71.05% of patients. Transient acute kidney injury with 50% sCr growth had 9 (8.1%) patients but didn’t require hemodialysis.

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Predictors of Concomitant Coronary Artery Disease and Major Cardiovascular Events in Patients with Acute Ischemic Stroke

Neurology India ◽

10.4103/0028-3886.323893 ◽

2021 ◽

Vol 69 (4) ◽

pp. 916

Author(s):

Beste Ozben ◽

Cigdem Ileri ◽

Zekeriya Dogan ◽

Murat Sunbul ◽

Burcu Bulut ◽

...

Keyword(s):

Coronary Artery Disease ◽

Ischemic Stroke ◽

Coronary Artery ◽

Acute Ischemic Stroke ◽

Cardiovascular Events ◽

Major Cardiovascular Events ◽

Artery Disease ◽

Concomitant Coronary Artery Disease

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Type 2 diabetes and risk of major cardiovascular events in peripheral artery disease versus coronary artery disease patients

European Heart Journal ◽

10.1093/eurheartj/ehab724.2035 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C H Saely ◽

A Vonbank ◽

B Larcher ◽

A Mader ◽

M Maechler ◽

...

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Peripheral Artery ◽

Major Cardiovascular Events ◽

Multivariate Adjustment ◽

Artery Disease

Abstract The prevalence of type 2 diabetes (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. The purpose of this study was to investigate how the incidence of major cardiovascular events compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes (T2DM). We prospectively recorded major cardiovascular events and death over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123). When compared to the incidence of MACE in CAD+/T2DM- patients (25.1%), it was significantly higher in CAD+/T2DM+ patients (35.4%; p<0.001), in PAD+/T2DM- patients (30.2%; p=0.022) and in PAD+/T2DM+ patients (47.2%; p<0.001). Patients with both PAD and T2DM in turn were at a higher risk than CAD+/T2DM+ or PAD+/T2DM- patients (p=0.001 and p<0.001, respectively). The incidence of MACE did not differ significantly between PAD+/T2DM- and CAD+/T2DM+ patients (p=0.413). Compared to patients with CAD, Cox regression analyses after multivariate adjustment showed an adjusted hazard ratio of 1.46 [1.14–1.87], p=0.002 for the presence of PAD. Conversely, T2DM increased the risk of MACE after multivariate adjustment in CAD and PAD patients (adjusted HR 1.58 [1.27–1.98], p<0.001). In conclusion, our data show that T2DM and the presence of PAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of MACE. FUNDunding Acknowledgement Type of funding sources: None.

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