Guideline-directed medical therapy in Polish patients with chronic coronary syndrome and advanced chronic kidney disease: insights from the ISCHEMIA-CKD trial.

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Postepy W Kardiologii Interwencyjnej Pub Date : 2026-03-09 eCollection Date: 2026-03-01 DOI:10.5114/aic.2026.160027

Radosław Pracoń, Rebecca Anthopolos, Ying Lu, Marcin Demkow, Tomasz Mazurek, Jarosław Drożdż, Piotr Pruszczyk, Marek Roik, Karolina Kryczka, Jan Henzel, Edyta Kaczmarska-Dyrda, Robert Małecki, Anna Teresińska, Hanna Szwed, Witold Rużyłło

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引用次数: 0

Abstract

Introduction: The ISCHEMIA-CKD trial showed similar outcomes with an initial conservative vs invasive approach to chronic coronary syndrome in patients with advanced chronic kidney disease. Guideline-directed medical therapy (GDMT) was recommended regardless of the randomized strategy assignment.

Aim: To describe GDMT attainment in ISCHEMIA-CKD participants in Poland compared to other world regions.

Material and methods: Among 777 trial participants, 105 were randomized in Poland. Patients were followed for a median of 2.2 years with the following GDMT recommendations: not smoking, systolic blood pressure (SBP) < 140/ diastolic blood pressure (DBP) < 90 mm Hg, high/moderate-intensity statin, antiplatelet/anticoagulant, angiotensin-converting-enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARB) and b-blocker therapy, glycated hemoglobin (HbA1c) < 8% when indicated.

Results: Participants in Poland vs other regions of the world (age 67 [60, 76] vs. 63 [55, 70] years, p < 0.001, 32% vs. 31% females, p = 0.86) had higher incidence of prior myocardial infarction (25% vs. 16%, p = 0.04), peripheral vascular disease (12% vs. 5%, p = 0.009), atrial fibrillation (23% vs. 7%, p < 0.001), and less frequently diabetes (44% vs. 59%, p = 0.004). At baseline, Polish participants were more often on antiplatelets/anticoagulants (91% vs. 83%, p = 0.04), b-blockers (95% vs. 72%, p < 0.001), and ACE-I/ARBs (62% vs. 45%, p = 0.002), with better attainment of SBP < 140 (73% vs. 53%, p < 0.001), and HbA1c < 8% (86% vs. 56%, p = 0.003) and similar smoking and high-/moderate-intensity statin treatment frequencies. This degree of GDMT goal attainment was maintained at the last follow-up visit.

Conclusions: In Polish patients with advanced kidney disease, high GDMT goal attainment was observed and maintained until the last follow-up visit under trial-specific, strict medical surveillance. The impact of GDMT on long-term outcomes remains to be studied in this patient population.

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波兰慢性冠状动脉综合征和晚期慢性肾病患者的指导药物治疗：来自缺血- ckd试验的见解

缺血- ckd试验显示，在晚期慢性肾病患者中，初始保守与侵入性入路治疗慢性冠状动脉综合征的结果相似。无论随机策略分配如何，都推荐指南导向药物治疗（GDMT）。目的：与世界其他地区相比，描述波兰缺血性ckd参与者的GDMT实现情况。材料和方法：在777名试验参与者中，105名随机在波兰进行。患者的中位随访时间为2.2年，GDMT建议：不吸烟，收缩压(SBP) < 140/舒张压(DBP) < 90 mm Hg，高/中强度他汀类药物，抗血小板/抗凝剂，血管紧张素转换酶抑制剂(ACE-I)/血管紧张素受体阻滞剂（ARB）和b受体阻滞剂治疗，糖化血红蛋白(HbA1c) < 8%。结果：波兰与世界其他地区的参与者（年龄67[60,76]对63[55,70]岁，p < 0.001, 32%对31%的女性，p = 0.86）相比，既往心肌梗死（25%对16%，p = 0.04）、外周血管疾病（12%对5%，p = 0.009）、心房颤动（23%对7%，p < 0.001）的发生率更高，糖尿病的发生率更低（44%对59%，p = 0.004）。在基线时，波兰参与者更常使用抗血小板/抗凝血剂（91%对83%，p = 0.04）， b受体阻滞剂（95%对72%，p < 0.001）和ACE-I/ arb(62%对45%，p = 0.002)，更好地达到收缩压< 140(73%对53%，p < 0.001), HbA1c < 8%（86%对56%，p = 0.003）和相似的吸烟和高/中强度他汀类药物治疗频率。这种GDMT目标的实现程度在最后一次随访时保持不变。结论：在波兰晚期肾病患者中，在试验特异性的严格医学监测下，观察到高GDMT目标达到并保持到最后一次随访。GDMT对该患者群体长期预后的影响仍有待研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Postepy W Kardiologii Interwencyjnej 医学-心血管系统

CiteScore

1.60

自引率

15.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Postępy w Kardiologii Interwencyjnej/Advances in Interventional Cardiology is indexed in: Index Copernicus, Ministry of Science and Higher Education Index (MNiSW). Advances in Interventional Cardiology is a quarterly aimed at specialists, mainly at cardiologists and cardiosurgeons. Official journal of the Association on Cardiovascular Interventions of the Polish Cardiac Society.