Researchers identify predictors or poor outcome for patients with stable coronary artery disease


Researchers have identified a number of predictors of ischemic events or death in patients with stable coronary artery disease (SCAD) in data presented at the 2021 American Heart Association (AHA) annual meeting.

A team, led by Alvaro Acena, MAdrid, evaluated the influence of estimated glomerular filtration rate (eGFR) on the prediction of parathyroid hormone (PTH) and other markers of mineral metabolism (MM) in patients with SCAD .

Forecasting issues

Parathyroid hormone, which is part of the mineral metabolism system, has recently been shown to be useful in predicting stable coronary artery disease and moderate renal function.

However, it is not known what the influence of renal function might be on the prediction of PTH in patients with SCAD.

In the study, researchers analyzed the prognostic value of different markers, including PTH, klotho, phosphate, calcidiol (25-hydroxyvitamin D3), and fibroblast growth factor-23. [FGF-23].

The study included 964 patients with SCAD and an eGFR 2 (LGFR), which were compared to patients with eGFR ≥60 ml / min / 1.73 m2 (HGFR) in 5 hospitals in Spain.


Investigators looked for the main outcomes of the combination of death with ischemic events based on acute coronary syndrome, ischemic stroke, or transient ischemic attack. They calculated eGFR using the Collaborative Chronic Kidney Disease Epidemiologic Equation (CKD-EPI).

Overall, 790 patients had HGFR and 174 participants had LGFR.

Predictors of ischemic events or death were plasma levels of calcidol [HR, 0.023; 95% CI, 0.94-0.99; P = 0.023], FGF23 [HR, 1.00; 95% CI, 1.00-1.003; P = 0.036], non-HDL cholesterol [HR, 1.01; 95% CI, 1.00-1.01; P = 0.026], and high sensitivity troponin [HR, 5.12; 95% CI, 1.67-15.59; P = 0.004 in the HGFR group]. Age was also a predictor (RR: 1.03; 95% CI: 1.01-1.05; P = 0.01].

Other predictors also included statin treatment [HR, 0.36; 95% CI, 0.19-0.68; P = 0.002], nitrates [HR, 1.13; 95% CI, 1.07-2.79; P = 0.027], dihydropyridines [HR, 1.71; 95% CI, 1.05-2.77; P = 0.032], verapamil [HR, 5.71; 95% CI, 1.35-24.1; P = 0.018], and proton pump inhibitors [HR, 2.23; 95% CI, 1.36-3.68; P = 0.002].

There were some similarities in the LGFR cohort. The predictors of death or ischemic events in this group were plasma PTH levels, [HR, 1.01; 95% CI, 1.00-1.01; P = 0.005], eGFR [HR, 0.96; 95% CI, 0.94-0.99; P = 0.004], age [HR, 1.06; 95% CI, 1.02-1.10; P = 0.003]Caucasian race [HR, 0.04; 95% CI, 0.004-0.380; P = 0.005], and insulin treatment [HR, 2.6; 95% CI, 1.20-5.63; P = 0.015].

“In [patients] with SCAD, PTH is an independent predictor of poor outcome only in people with eGFR 2 , while in [patients] with eGFR≥60 ml / min / 1.73 m2 calcidiol and FGF-23 become the only components of MM that can predict prognosis, ”the authors wrote. “Next, renal function influences the predictive power of MM markers in [patients] with SCAD.

The study, “Mineral Metabolism Predictors Poor in Stable Coronary Artery Disease With and Without Impaired Kidney Function,” was published online by AHA.


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