Relationship between the severity of coronary artery disease and renal function

Abstract

The American Heart Association’s Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations establishedestimated glomerular filtration rate (eGFR) as a component of cardiovascular risk assessment. However, the anatomicalsubstrate underlying this risk—coronary atherosclerotic burden—remains inadequately characterized across renal functionspectrum. This retrospective study included 1181 patients (mean age: 60.2 ± 8.9 years, 65.7% male) undergoing electivecoronary angiography. Patients divided groups using eGFR; eGFR ≥90 (n = 596), 60 to 89 (n = 497), and 30 to 59 mL/min/1.73 m 2 (n = 88) were evaluated by stratification. Coronary atherosclerotic burden was determined using Gensini score.eGFR demonstrated a strong correlation with Gensini score (ρ = −0.352, P < .001). Each 10 mL/min/1.73 m 2 eGFR declineconferred 40% increased odds of severe coronary atherosclerosis (odds ratio [OR] = 0.960, 95% CI: 0.951-0.970, P < .001).Patients with eGFR 30 to 59 mL/min/1.73 m2 exhibited 6-fold higher odds compared with preserved renal function (OR6.073, 95% CI: 3.352-11.005, P < .001), independent of traditional risk factors. This study provides an anatomical validationfor incorporating eGFR into cardiovascular risk assessment. Our angiographic evidence demonstrates that even mild renaldysfunction is accompanied by increased atherosclerotic burden. These findings bridge the gap between epidemiological riskprediction and pathophysiological reality, reinforcing the cardiovascular-kidney-metabolic health continuum and supportingaggressive risk modification strategies in patients with declining renal function, particularly among diabetic women.