Investigators Identify Predictors or Poor Outcomes for Patients with Stable Coronary Artery Disease

Dr. Alvaro Acena

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

A team, led by Alvaro Acena, MAdrid, assessed the influence of estimated glomerular filtration rate (eGFR) on predicting Parathormone (PTH) and other Mineral Metabolism (MM) markers in patients with SCAD.

Forecasting Problems

Parathormone, part of the Mineral Metabolism system, has recently shown value in forecasting stable coronary artery disease and average renal function.

However, it is uncertain what the influence of renal function on forecasting PTH on patients with SCAD might be.

In the study, the investigators 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 <60 ml/min/1.73 m² (LGFR), which were compared to patients with eGFR≥60 ml/min/1.73 m² (HGFR) at 5 hospitals in Spain.

Outcomes

The investigators sought main outcomes of the combination of death with ischemic events based on any acute coronary syndrome, ischemic stroke, or transient ischemic attack. They calculated eGFR using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI).

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

The 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 (HR, 1.03; 95% CI, 1.01-1.05; P = 0.01].

Other predictors also included treatment with statins [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. Predictors of death or ischemic events in this group were PTH plasma levels, [HR, 1.01; 95% CI, 1.00-1.01; P = 0.005], the 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 treatment with insulin [HR, 2.6; 95% CI, 1.20-5.63; P = 0.015].

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

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