Relationship Between the Severity of Coronary Artery Disease and Renal Function

The American Heart Association’s Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations established estimated glomerular filtration rate (eGFR) as a component of cardiovascular risk assessment. However, the anatomical substrate underlying this risk—coronary atherosclerotic burden—remains inadequately characterized across renal function spectrum. This retrospective study included 1181 patients (mean age: 60.2 ± 8.9 years, 65.7% male) undergoing elective coronary 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 decline conferred 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 m 2 exhibited 6-fold higher odds compared with preserved renal function (OR 6.073, 95% CI: 3.352-11.005, P < .001), independent of traditional risk factors. This study provides an anatomical validation for incorporating eGFR into cardiovascular risk assessment. Our angiographic evidence demonstrates that even mild renal dysfunction is accompanied by increased atherosclerotic burden. These findings bridge the gap between epidemiological risk prediction and pathophysiological reality, reinforcing the cardiovascular-kidney-metabolic health continuum and supporting aggressive risk modification strategies in patients with declining renal function, particularly among diabetic women.