Introduction:
Chronic kidney disease (CKD) is a major clinical problem worldwide and is one of the leading causes of health disability. CKD patients have an increased premature mortality mostly because of higher incidence of cardiovascular disease. As CKD stage worsens, the probability of developing coronary artery disease (CAD) increases. Despite the high risk, coronary angiogram is infrequently offered in patients with CKD. And as diagnostic contrast studies are rare, to understand whether we are justified in our reluctance of evaluating and appropriately managing coronary artery disease a prospective cohort study was done in two centers in India and Bangladesh (one from each country). This collaboration was aimed not only to understand the anatomy of coronary arteries in various stages of CKD patients in whom coronary angiogram was performed by cardiologists, but also to note whether there were any differences in the practice patterns in the management of CAD in these two countries of the Indian sub-continent.
Methods:
All consecutive patients who underwent a coronary angiogram in two tertiary care hospitals (one in India and another in Bangladesh) were included in the study. Their demographics (age, gender) underlying comorbidities (diabetes mellitus, hypertension) , clinical presentation (stable angina, unstable angina , Non ST segment myocardial infarction and myocardial infarction ) , type of coronary lesions treatment and one year mortality outcome was noted. Regression analysis was performed to look at variables which had an impact on outcome.
Results:
A total of 419 (317 India and 102 Bangladesh) CKD patients underwent (CAG) during the study period. Majority of the patients were males (n= 249 ,78.5 %).he age ranged from 28 to 63 years. Mean (sd) age of the Indian cohort was 62.3(10.3) years whereas the Bangladeshi patients age was 53.3(10.2 years). The creatinine ranged from 0.8 mg /dl to 12.6 mg/dl. Diabetes mellitus was seen in 238 patients whereas hypertension was noted in 259 patients. The mean (sd) creatinine of the India cohort was 2.5(1.8) and that of the Bangladesh cohort was 1.9(0.3) mg/dl. Majority of the patients were in CKD Stage 3 (n= 270 64.4%). Only 40 (9.5%) patients were in CKD Stage 5. Echocardiographically, regional wall motion abnormality was noted in 270 patients. (67.2% in the Indian cohort and 55.9% in the Bangladeshi cohort (p=0.038)). Contrary to expectations left ventricular hypertrophy was seen in only 32.7% of patients. The commonest coronary artery involved was the left anterior descending artery (339/419). 85% of the Indian patients had LAD lesions compared to 67.6% Bangladeshi patients (p=0.000) In the severity of LAD 74% of Indian patients had >70% occlusion compared to 54% of Bangladeshi patients who had>70% stenosis. Though not significant, > 50% triple vessel disease was seen in stage 5 CKD. 317 (75.6%) underwent percutaneous transluminal coronary angioplasty (PTCA) and 81 (19.3%) underwent coronary artery bypass grafting (CABG). Only 21 out of 419 patients were offered conservative management. One year outcome data was available in 355 (84.7%) patients. At one year 307 patients were alive. 86.5% of patients who underwent PTCA were alive at one year and 82.4% of patients who underwent CABG were alive at one year. The type of treatment offered had no significant impact on the one -year outcome.
Conclusions:
The coronary lesions studied appeared to less severe in Bangladesh cohort. More Bangladeshi patients were offered medical management. The type of treatment offered to the patients had no major impact on the one year outcome.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.