Abstract 3507: Optimal Medical Therapy With or Without Percutaneous Coronary Intervention for Stable Coronary Artery Disease is Effective in Patients with Chronic Kidney Disease
Bibliographic record
Abstract
Background : Chronic kidney disease (CKD) is a risk factor for poor outcomes in patients with CAD. Optimal management of such patients is uncertain. CKD patients (especially those with diabetes) are at risk for contrast nephropathy potentially limiting the benefits of percutaneous coronary intervention (PCI). Methods: To evaluate the impact of adding PCI to optimal medical therapy (OMT) in CKD patients with stable CAD we analyzed outcomes stratifying by renal function in the COURAGE trial. We used the abbreviated Modification of Diet in Renal Disease equation to estimate glomerular filtration rate (GFR). Results: A total of 2287 patients were enrolled in COURAGE. Of those, 30% (n=536) had CKD defined as GFR <60mL/min/1.73m 2 . CKD was present in 26% of OMT patients and 21% of OMT +PCI patients. The CKD group was older (66 ±10 versus 61 ± 9.6years P<0.001) had more females (24% versus 12 % p<0.001) more hypertension (71% versus 66% p <0.03) and higher systolic blood pressure (135 ±21 versus 131 ± 19mm/Hg p =<0.001). There was a trend to more diabetes (37% versus 34% p <0.22) and 3 vessel CAD (33% versus 30% p <0.09). ACEI or ARB use was 76% in CKD patients. By 36 months there was similar and intensive risk factor control in patients with and without CKD (systolic blood pressure 125 ± 17 versus 125 ± 17mmHg, LDL 79 ± 24 versus 78 ± 26mg/dL respectively p = NS). The primary composite end-point of COURAGE (death or MI) did not differ by treatment in patients with or without CKD. Rates of death, MI, CHF and angina-free survival at 36 months stratified by treatment status in patients with GFR>60 versus patients with GFR > 60 are shown in the table . Conclusion: Patients with CKD and chronic stable angina when treated with OMT to aggressive blood pressure and lipid goals have marked and sustained improvement in angina similar to patients without CKD. Furthermore, patients with CKD can safely undergo PCI for improved angina control without excess death, MI or CHF when compared to patients treated by OMT alone.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".