Kidney Week

Abstract: FR-PO355

Effect of Coronary Revascularization on the Association of Elevated Troponin with Post-Dialysis Mortality in Patients with Advanced CKD

Session Information

• Hypertension and CVD: Clinical, Outcomes, Trials
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

• Koshy, Santhosh K., Regional One Health - University of TN Health Sciences Ctr, Memphis, Tennessee, United States

Santhosh K. Koshy,

• George, Lekha K., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Lekha K. George,

• Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Miklos Zsolt Molnar,

• Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Praveen Kumar Potukuchi,

• Gaipov, Abduzhappar, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Abduzhappar Gaipov,

• Agarwal, Manyoo, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Manyoo Agarwal,

• George, Koshy K., University of Queensland, Memphis, Tennessee, United States

Koshy K. George,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Kovesdy, Csaba P., Memphis VA Medical Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

Background

Coronary revascularization (CR), supported by its long-term mortality benefit, is indicated for high risk acute coronary syndrome as evidenced by elevated troponin. Patients with CKD often present with higher and sustained levels of troponin due to reduced clearance, causing diagnostic uncertainty and potentially resulting in fewer patients receiving CR. The incidence of CR and its benefits on long-term mortality in patients with advanced CKD and elevated troponin levels is unclear.

Methods

We examined 16,759 US veterans who had troponin measured during the 3 years prior to start of dialysis. We examined the association between troponin level and future CR, and whether or not future CR modifies the association between troponin levels and subsequent mortality. We modelled the risk of mortality associated with the highest recorded troponin level in time-dependent Cox models including the interaction between troponin and future CR, while adjusting for demographics, comorbidities, smoking status, blood pressure, BMI and baseline eGFR.

Results

Patients were 66±10 years old, 97% male, 37% African-American and 77% diabetic. CR was performed in only 326 patients (2%) following a troponin measurement, and higher troponin was associated with future CR (multivariable adjusted hazard ratio and 95%CI in fourth [>0.25 ng/ml] vs. first quartile [<0.03 ng/ml] of troponin: 6.35 [4.26-9.46]). Death occurred in 11,315 patients (67%). Higher troponin was associated with linearly higher mortality in patients who did not undergo CR (Figure). Patients who underwent CR experienced numerically lower risk of death associated with troponin levels compared to those without CR (Figure), but the interaction was not statistically significant.

Conclusion

CR may be associated with lower post-dialysis mortality in patients with advanced CKD and elevated troponin. The potential benefit of CR in this population needs to be explored further in large prospective studies.

Funding

• NIDDK Support