Effects of Long-Term Statin Therapy in Coronary Artery Disease Patients with or without Chronic Kidney Disease

Introduction.The effect of long-term statin therapy is essential for secondary prevention of adverse clinical outcomes of coronary artery disease (CAD) patients. No study has compared the effects of long-term statin treatment in CAD patients with or without chronic kidney disease (CKD) and CKD only patients.Methods.We compared the effects of long-term statin therapy (average follow-up time 5.79 years) in terms of major adverse cardiovascular events (MACE), all-cause death, and cardiac death among 570 CAD patients with or without CKD and 147 CKD only patients.Results.The all-cause death and cardiac death of the patients with CAD and CKD (24.4% and 20.4%) doubled those of CAD only patients (10.7% and 9.1%) (P<0.001). Long-term statin therapy dramatically reduced the rates of both MACE and all-cause death/cardiac death (by 20.5% and 28.6%/27.7%, resp.) in CAD and CKD patients. CKD only patients had no significant adverse clinical outcomes and were not responsive to long-term statin therapy.Conclusion.Chinese CAD patients with CKD had dramatically high rates of adverse clinical outcomes; for them, long-term statin therapies were exceptionally effective in improving morbidity and mortality. CKD patients who had no cardiovascular disease initially can prognose good clinical outcomes and do not require statin treatment.

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Serum Potassium Levels and Risk of Sudden Cardiac Death Among Patients With Chronic Kidney Disease and Significant Coronary Artery Disease

Kidney International Reports ◽

10.1016/j.ekir.2017.07.001 ◽

2017 ◽

Vol 2 (6) ◽

pp. 1122-1131 ◽

Cited By ~ 19

Author(s):

Patrick H. Pun ◽

Benjamin A. Goldstein ◽

John A. Gallis ◽

John P. Middleton ◽

Laura P. Svetkey

Keyword(s):

Coronary Artery Disease ◽

Chronic Kidney Disease ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Kidney Disease ◽

Serum Potassium ◽

Cardiac Death ◽

Significant Coronary Artery Disease ◽

Artery Disease

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Effects of statin treatment in patients with coronary artery disease and chronic kidney disease

Heart and Vessels ◽

10.1007/s00380-013-0325-2 ◽

2013 ◽

Vol 29 (1) ◽

pp. 21-28 ◽

Cited By ~ 27

Author(s):

Hidehiro Kaneko ◽

Junji Yajima ◽

Yuji Oikawa ◽

Shingo Tanaka ◽

Daisuke Fukamachi ◽

...

Keyword(s):

Coronary Artery Disease ◽

Chronic Kidney Disease ◽

Coronary Artery ◽

Kidney Disease ◽

Statin Treatment ◽

Artery Disease

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Comparison of modification of diet in renal disease and chronic kidney disease epidemiology collaboration formulas in predicting long-term outcomes in patients undergoing stent implantation due to stable coronary artery disease

Clinical Research in Cardiology ◽

10.1007/s00392-014-0687-1 ◽

2014 ◽

Vol 103 (7) ◽

pp. 569-576 ◽

Cited By ~ 8

Author(s):

Tadeusz Osadnik ◽

Jarosław Wasilewski ◽

Andrzej Lekston ◽

Joanna Strzelczyk ◽

Anna Kurek ◽

...

Keyword(s):

Coronary Artery Disease ◽

Chronic Kidney Disease ◽

Coronary Artery ◽

Kidney Disease ◽

Renal Disease ◽

Stable Coronary Artery Disease ◽

Long Term Outcomes ◽

Disease Epidemiology ◽

Artery Disease

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Treatment of complex coronary artery disease in patients with diabetes mellitus and chronic kidney disease: 10-year results comparing outcomes of CABG and PCI in the SYNTAXES trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.2520 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Gao ◽

R.T Wang ◽

K Takahashi ◽

H Kawashima ◽

R.J Van Geuns ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery Disease ◽

Chronic Kidney Disease ◽

Coronary Artery ◽

Kidney Disease ◽

Funding Source ◽

Private Company ◽

All Cause Mortality ◽

Artery Disease

Abstract Background The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of the SYNTAX trial, which was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease. The SYNTAXES study is the first randomized trial that reported the complete 10-year data on all-cause death in patients with complex coronary artery disease. Purpose Patients with coronary artery disease (CAD) and concomitant diabetes mellitus (DM) or chronic kidney disease (CKD) are more susceptible to major adverse cardiovascular and cerebrovascular events. However, to date, the long-term prognosis and which revascularization strategy was associated with better clinical outcomes for patients with complex coronary artery disease and concomitant with DM and CKD have not been documented. Methods In this sub-analysis of the SYNTAXES trial, a total of 1,638 patients were classified into four subgroups according to the DM and CKD status: DM−/CKD− (n=999, 60.1%), DM+/CKD− (n=323, 19.7%), DM−/CKD+ (n=231, 14.1%), and DM+/CKD+ (n=85, 5.2%). The treatment effects of PCI and CABG were analyzed in each subgroup. The primary endpoint was all-cause death at 10 years. Results Compared with the DM−/CKD− patients, patients with DM+/CKD+ were older, more often had a history of stroke, hypertension, heart failure, and were more frequently presented with total occlusion, bifurcation lesion and three-vessel disease. At 10 years, patients with DM+/CKD+ had a 3.94-fold higher incidence of all-cause mortality compared with DM−/CKD− individuals (54.1% versus 18.9%, 95% CI [2.85–5.44]). Patients with DM−/CKD+ (38.1%, HR 2.36; 95% CI [1.83–5.44]) or DM+/CKD− (28.2%, HR 1.61; 95% CI [1.26–2.07]) had intermediate risk profile. For DM+/CKD+ patients, compared with PCI, those who underwent CABG were associated with lower incidence of all-cause mortality (64.3% versus 44.2%, adjusted HR 0.52; 95% CI [0.27–0.99], p=0.047, pinteraction=0.443). The number of needed-to-treat to reduce mortality for CABG was 12. Conclusion In the SYNTAX population, patients with DM and CKD are at markedly increased risk of long-term mortality rate compared with patients one or neither of these risk factors. For patients with both comorbidities, CABG was associated with better clinical outcome compared with PCI. These findings should be interpreted as hypothesis-generating. Figure 1. Kaplan-Meier curves showing the clinical events according to treatment and DM/CKD status. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Boston Scientific Corporation

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