Polyvascular disease in patients with myocardial infarction and chronic kidney disease

Aim. To study polyvascular disease in patients with myocardial infarction (MI) and chronic kidney disease (CKD). Materials and methods. A total of 954 patients older than 18 years old with ST-segment elevation MI (STEMI) up to 24 hours of pain onset were included in the study. Clinical and demographic data were collected for all patients, including physical examination, 16-lead electrocardiogram recording, echocardiography, laboratory assessment with the measurements of cardiospecific enzymes and serum creatinine. Glomerular filtration rate (GFR) was estimated according to the CKD-EPI equation. Of them, 771 (81%) underwent coronary angiography, duplex scanning of the brachiocephalic (BCA) and lower extremity arteries (LEA). Patients with stage 1-4 CKD diagnosed according to the criteria provided by the Russian Society of Nephrologists were allocated into a separate group (n=281; 36.5%). CKD stages were determined with the level of GFR. Patients with stage 5 CKD were excluded from the study. Renal dysfunction was defined as the presence of an estimated GFR less than 60 ml/min/1.73 m(2). Results and discussion. The results of the study indicate a high prevalence of PolyVD in patients with CKD. Every second patient had LEA stenosis (p< 0.001), and every fifth patient had multiple arterial bed lesions (i3 arterial beds; p=0.018), multiple coronary artery disease (p< 0.001), independently from kidney function. Patients with stage 1 and 2 CKD commonly had hemodynamically insignificant arterial stenoses (< 30%; p=0.036), whereas stage 3 and 4 CKD patients had significant stenotic lesions (p< 0.05). Patients with stage 3 and 4 CKD more frequently suffered from three and more arterial bed lesions (p=0.030). Logistic regression reported that renal dysfunction (stage 3 CKD and above) was considered as an independent predictor of PolyVD. Conclusion. CKD is associated with highly prevalent and severe PolyVD. The severity of PolyVD is directly related to the stage of renal dysfunction (CKD stage).