Predictors of Severe Coronary Artery Lesions Among Patients with End Stage Renal Disease

Pabba, Krishna

Predictors of Severe Coronary Artery Lesions Among Patients with End Stage Renal Disease

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Krishna Pabba, MD , UT Medical School At Houston, Houston, TX

Fisayomi Shobayo, MD , Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX

Michael Hust, MD , Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX

Tariq E Thannoun, MD , UT Houston, Houston, TX

Vicent Gacad, MD , Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX

Gabriel Aisenberg, MD , Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX

Background
Coronary atherosclerosis is highly prevalent among patients with end stage renal disease (ESRD) undergoing hemodialysis. Risk stratification tools have not been specifically created for these patients to determine when coronary angiography is necessary, therefore making the diagnostic evaluation of acute coronary syndrome a clinical challenge. Making the correct diagnosis in a timely manner has substantial effects on patient outcomes, especially in public hospitals without percutaneous coronary intervention (PCI) capabilities, such as ours. This study aims to determine predictors of severe coronary atherosclerosis in patients with ESRD.

Methods
We retrospectively identified patients 18 years of age or older with ESRD on dialysis admitted to our hospital between 2010 to 2017, who had undergone a coronary angiogram during the hospitalization. The main outcome variable was the presence and severity of coronary atherosclerotic lesions. A multiple regression model was used to find predictors of severe coronary lesions, defined as those that would benefit from revascularization.

Results
Among 238 patients, 130 (56%) patients had angiographic severe coronary lesions, 52 (22%) had less than severe lesions, and 51 (22%) had no coronary lesions. Markers that were associated with severe coronary atherosclerosis were diabetes mellitus (P=0.0004), new ST depressions (P=0.0004), elevated serum troponin I levels (P=0.005), and angina pectoris (P=0.03).

Conclusions
These findings identify a potential role for these markers to be incorporated into future diagnostic and therapeutic strategies aimed at the earlier detection and management of high risk coronary atherosclerosis in the hospital setting, especially when resources are limited.