Abstract
Background and Aims
to study of renal function in patients with coronary artery disease, depending on the method of revascularization and the initial state of the kidneys.
Method
There were 160 patients with coronary artery disease under observation who underwent re-endovascular procedures (RE). The average age of the patients was 56.6 ± 1.27 years. Coronary artery bypass grafting (CABG group) was performed in 21 patients with coronary artery disease and percutaneous coronary intervention (PCI group) - in 139 patients. The study included patients with an eGFR of at least 60 ml / min, determined by the serum creatinine concentration. Patients received standard therapy: antiplatelet therapy (double therapy), bisoprolol, valsartan, atorvastatin. All patients underwent dynamic determination of serum creatinine concentration in terms of 3 months - 1 year -2 years.
Results
The CABG groups (21 patients) and the PTCA group (139 patients) who received standard therapy for coronary artery disease (group B). In the CABG and PCI groups, the eGFR was 105.66 ± 3.74 ml / min and 102.71 ± 1.59 ml / min, respectively. By the 3rd month of follow-up, the dynamics of eGFR in the groups, did not differ (-16.36 ± 3.30% and -17.55 ± 1.25%, respectively), by the 3rd month eGFR observation in the CABG and PTCA groups was also comparable, although it also differed in the baseline data (90.14 ± 6.05 ml / min and 86.46 ± 2.37 ml / min, respectively, the differences with the baseline data in both groups - p < 0.001. By the end the 1st year the following pattern emerged: in patients who underwent surgical revascularization, the decrease in eGFR was more pronounced than in patients who underwent stenting of the coronary arteries (-51.80 ± 3.51% versus -42, 39 ± 1.35%, p <0.05), and the differences increased even more during the second year of observation (-57.99 ± 4.75% versus -44.76 ± 1.89%, p <0.05). The second year of observation, eGFR in the CABG group was lower than in the PTCA group (44.63 ± 5.37 ml / min versus 56.54 ± 2.01 ml / min, p <0.05). This pattern can be explained that fact in the CABG group were more patients with diabetes - 80.95% (17 patients out of 21) compared with PTCA patients - 12.23% (17 patients out of 139, chi square 49.83, p < 0.001). All patients divided into 2 subgroups depending on the degree of eGFR by the 3rd month of observation: patients with eGFR by the 3rd month of observation more than 20% (31 patients, group 1) and less than 20% (group 2 - 129 sick). Initially, eGFR in group 1 was lower than in group 2. The relative dynamics of eGFR during the entire observation period was greater in patients of group 1 compared with group 2 (-43.58 ± 1.72% versus -11.10 ± 0.58% by the end 3rd month of observation, -61.30 ± 1.44% versus -39.38 ± 1.29% by the end of the first year and -68.78 ± 2.56% versus -41.14 ± 1.85% by the end of the second year of observation, the reliability of the difference in the relative dynamics between the groups at all three observation points is p <0.001).
Conclusion.
In patients with coronary artery disease who underwent coronary revascularization, there is a decrease in renal function after revascularization. The most significant decrease was observed in patients undergoing coronary artery bypass grafting, as well as in patients with initially low filtration function of the kidneys.
Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease
