Burak HÜNÜK, Cihan ŞENGÜL, Ayça CABBAR TÜRER, Sinan AYDIN, Muzaffer DEĞERTEKİN, Olcay ÖZVEREN, Emre ASLANGER, Mustafa Aytek ŞİMŞEK

Sol Ana Koroner Hastalığı Prevalansının Kronik Böbrek Yetersizliği Olan ve Olmayan Hastalarda Karşılaştırılması: Eğilim Skor Eşleştirme Analizi

Amaç: Bu çalışmada kronik böbrek hastalığına KBH sahip hastalarda sol ana koroner LMCA hastalığının prevalansını ve bu prevalansın normal böbrek fonksiyonuna sahip hastalardan farklı olup olmadığını saptamayı amaçladık.Gereç ve Yöntemler: Koroner anjiyografi uygulanmış 502 ardışık stabil koroner arter hastası tarandı. 423 hasta son değerlendirmeye dahil edildi. LMCA hastalığının prevalansı KBH olan veya olmayan hasta gruplarında karşılaştırıldı. Eğilim skor analizi yöntemi ile 102 kronik böbrek yetersizliği hastası 102 normal böbrek fonksiyonuna sahip hasta ile eşleştirildi ve LMCA hastalığının sıklığı bu iki grupta karşılaştırıldı. Bulgular: Ortanca yaş 61,08±10,23 idi. KBH grubunda erkek cinsiyet ve diyabet anlamlı olarak daha fazla, sigara kullanımı ise anlamlı olarak daha azdı. Ortalama Gensini skoru KBH grubunda anlamlı olarak daha fazlaydı 58,66±33,77 vs. 57,62±28,69, p:0,002 . LMCA’da herhangi bir lezyon veya kritik lezyon varlığı iki grupta benzerdi. Birebir eğilim skor analizi yöntemi ile 102 KBH hastası 102 normal böbrek fonksiyonuna sahip hasta ile eşleştirildi. LMCA hastalığı sıklığı bu iki grupta yine benzer bulundu sırasıyla %21 vs %17,6, p:0,481 .Sonuç: KBH’ye sahip hastalarda kritik LMCA hastalık prevalansı normal böbrek fonksiyonuna sahip hastalardakinden farklı değildir. Bu benzerlik eğilim skor analizi sonrası da değişmemiştir

Anahtar Kelimeler:

Sol ana koroner hastalığı, Kronik böbrek hastalığı, Eğilim skor eşleştirme analizi

Comparison of Left Main Coronary Disease Prevalance in Patients with or without Chronic Kidney Disease: A Propensity Score Match Analysis

Objective: In our study we sought to determine the prevalence of critical left main coronary artery LMCA disease in chronic kidney disease CKD and to compare it with the prevalence in patients with normal kidney function.Material and Methods: 502 consecutive patients with stable angina pectoris who underwent coronary angiography were screened. 423 patients were included in the final analysis. Prevalence of LMCA disease was compared between patients with or without CKD. 102 patients with CKD were matched with 102 patients without CKD using propensity score matching and the prevalence of LMCA disease was compared between these groups. Results: Mean age was 61.08±10.23. Male gender and diabetes were significantly higher whereas smoking was significantly lower in patients with CKD. Mean Gensini score was higher in patients with CKD 58.66±33.77 vs. 57.62±28.69, p:0.002 . Presence of any lesion or significant stenosis in LMCA did not differ between the groups. 102 patients with CKD matched with 102 patients with normal kidney function after 1:1 propensity score analysis. Prevalence of critical LMCA disease did not differ between matched CKD and non CKD groups 21% vs 17.6% respectively, p: 0.481 .Conclusion: In patients with CKD, the prevalence of a critical LMCA lesion was not different from the patients with normal kidney function. The similarity of the prevalence persisted after propensity score matching

Keywords:

Left main coronary disease, Chronic kidney disease, Propensity score match analysis,

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Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, Hobbs FD. Global prevalence of chronic kidney disease - A systematic review and meta-analysis. PloS One 2016; 11(7):e0158765.
Briasoulis A, Bakris GL. Chronic kidney disease as a coronary artery disease risk equivalent. Current Cardiology Reports 2013; 15(3):340.
Thompson S, James M, Wiebe N, Hemmelgarn B, Manns B, Klarenbach S, Tonelli M, Alberta Kidney Disease N. Cause of death in patients with reduced kidney function. Journal of the American Society of Nephrology 2015; 26(10):2504-11.
Drueke TB, Massy ZA. Atherosclerosis in CKD: differences from the general population. Nature Reviews Nephrology 2010; 6(12):723-35.
Giustino G, Mehran R, Serruys PW, Sabik JF, 3rd, Milojevic M, Simonton CA, Puskas JD, Kandzari DE, Morice MC, Taggart DP, Gershlick AH, Genereux P, Zhang Z, McAndrew T, Redfors B, Ragosta M, 3rd, Kron IL, Dressler O, Leon MB, Pocock SJ, Ben-Yehuda O, Kappetein AP, Stone GW. Left main revascularization with PCI or CABG in patients with chronic kidney disease: EXCEL trial. Journal of the American College of Cardiology 2018; 72(7):754-65.
Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. The American Journal of Cardiology 1983; 51(3):606.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Annals of Internal Medicine 1999; 130(6):461-70.
Bangalore S, Maron DJ, Fleg JL, O’Brien SM, Herzog CA, Stone GW, Mark DB, Spertus JA, Alexander KP, Sidhu MS, Chertow GM, Boden WE, Hochman JS, Group I-CR. International Study of Comparative Health Effectiveness with Medical and Invasive Approaches- Chronic Kidney Disease (ISCHEMIA-CKD). Rationale and design. American Heart Journal 2018; 205:42-52.
Zannad F, Rossignol P. Cardiovascular outcome trials in patients with advanced kidney disease: Time for Action. Circulation 2017; 135(19):1769-71.
Charytan D, Kuntz RE. The exclusion of patients with chronic kidney disease from clinical trials in coronary artery disease. Kidney International 2006; 70(11):2021- 30.
De Luca L, Temporelli PL, Lucci D, Colivicchi F, Calabro P, Riccio C, Amico A, Mascia F, Proia E, Di Lenarda A, Gulizia MM, Investigators S. Characteristics, treatment and quality of life of stable coronary artery disease patients with or without angina: Insights from the START study. PloS One 2018; 13(7):e0199770.
Lee PH, Lee JY, Lee CW, Han S, Ahn JM, Park DW, Kang SJ, Lee SW, Kim YH, Park SW, Park SJ. Long- term outcomes of bypass grafting versus drug-eluting stenting for left main coronary artery disease: Results from the IRIS-MAIN registry. American Heart Journal 2017; 193:76-83.
Dan K, Miyoshi T, Ueeda M, Ohtsuka H, Ugawa S, Ohnishi N, Takaishi A, Nakamura K, Kusano K, Ito H. Impact of chronic kidney disease on left main coronary artery disease and prognosis in Japanese patients. Circulation Journal 2012; 76(9):2266-72.
Gehani AA, El-Menyar A, Elgendy I, Abuzaid A, Ahmed E, Haque S. Clinical presentation and cardiovascular risk profiles in patients with left main coronary artery disease in a middle eastern country. Angiology 2013; 64(3):195-9.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. New England Journal of Medicine 2004; 351(13):1296-305.