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Cardiovascular events in patients with deferred lesions and chronic kidney disease

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Abstract

No study has reported the association between the worsening of chronic kidney disease (CKD) and cardiovascular events in patients with deferred coronary artery lesions. We included patients with deferred lesions, defined as a fractional flow reserve (FFR) value > 0.80 treated with conservative medical therapy. Patients were divided into three groups: group 1, CKD stages 1–2; group 2, CKD stages 3–5; and group 3, CKD stage 5D (hemodialysis), with the clinical outcomes compared. The primary endpoint was the first occurrence of target vessel myocardial infarction, ischemia-driven target-vessel revascularization, or all-cause death. The primary endpoint was noted in 17, 25, and 36 patients in groups 1, 2, and 3, respectively. Within the three groups, the incidence rate of deferred lesions was 7.0%, 10.4%, and 32.4%, respectively. No difference was observed in the incidence of the primary endpoint between groups 1 and 2 (log-rank p = 0.16). However, the patients in group 3 had a significantly higher risk for the primary endpoint than those in groups 1 and 2 (log-rank p < 0.0001). In the multivariate Cox proportional hazards model, the patients in group 3 exhibited a higher incidence of the primary endpoint than those in group 1 (HR: 2.14; 95% CI 1.02–4.49; p < 0.01). Careful management is needed in patients undergoing hemodialysis, even if coronary artery stenosis is considered a deferred lesion.

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Data availability

The data that support the findings of this study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank our study’s participants, staff, and investigators for their contributions. We thank Editage (www.editage.com) for assisting with English language editing and publication.

Funding

No extramural funding was provided to support this study.

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Author notes

  1. Takehiro Hata and Hisao Otsuki contributed equally as the first authors of this study.

Authors and Affiliations

  1. Department of Cardiology, Tokyo Women’s Medical University, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan

    Takehiro Hata, Hisao Otsuki, Hiroyuki Arashi, Masashi Nakao & Junichi Yamaguchi

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  1. Takehiro Hata
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  2. Hisao Otsuki
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  3. Hiroyuki Arashi
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  4. Masashi Nakao
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  5. Junichi Yamaguchi
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Contributions

HO and HA conceptualized and designed the study. TH, HO, HA, YI, and MN collected data and enrolled and followed up with patients. TH and HO analyzed and interpreted the data. TH, HO and HA drafted and wrote the manuscript. HA and JY reviewed the manuscript. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and could take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Hiroyuki Arashi.

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Competing interests

HO, HA, and JY report that they are affiliated with the Division of Clinical Research Division for Cardiovascular Catheter Intervention and are financially supported by a donation from Abbott, Boston Scientific, Medtronic, and Terumo.

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Hata, T., Otsuki, H., Arashi, H. et al. Cardiovascular events in patients with deferred lesions and chronic kidney disease. Heart Vessels 38, 1364–1370 (2023). https://doi.org/10.1007/s00380-023-02285-2

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