An overview of percutaneous coronary intervention in dialysis patients: Insights from a Japanese nationwide registry

Abstract

Objectives This study sought to provide an overview of percutaneous coronary intervention (PCI) in dialysis patients from a Japanese nationwide registry. Background Little is known about dialysis patients undergoing PCI because few are enrolled in clinical trials. Methods We analyzed 624,900 PCI cases including 41,384 dialysis patients (6.6%) from 1,017 Japanese hospitals between 2014 and 2016. We investigated differences in characteristics and in‐hospital outcomes between dialysis and nondialysis patients, and assessed factors associated with an increased risk of adverse outcomes. Results Dialysis patients had more comorbidities than nondialysis patients and higher rates of complications including in‐hospital mortality (3.3% vs. 1.5%, respectively, in the acute coronary syndrome [ACS] cohort, 0.2% vs. 0.1% in the non‐ACS cohort) and bleeding complications requiring blood transfusion (1.1% vs. 0.4% in ACS, 0.5% vs. 0.2% in non‐ACS). Dialysis was significantly associated with an increased risk of in‐hospital mortality (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.24–1.62 in ACS, OR: 2.25, 95% CI: 1.66–3.05 in non‐ACS) and bleeding (OR: 1.60, 95% CI: 1.30–1.96 in ACS, OR: 1.55, 95% CI: 1.27–1.88 in non‐ACS). For dialysis patients, age, acute heart failure, and cardiogenic shock were associated with an increased risk of in‐hospital mortality in the ACS cohort, whereas age, female gender, and history of heart failure were associated with higher in‐hospital mortality in the non‐ACS cohort. Conclusions PCI was widely performed for dialysis patients with either ACS or non‐ACS in Japan. Dialysis patients had a greater risk of adverse outcomes than nondialysis patients after PCI.

Association of the Hemoglobin to Serum Creatinine Ratio with In-Hospital Adverse Outcomes after Percutaneous Coronary Intervention among Non-Dialysis Patients: Insights from a Japanese Nationwide Registry (J-PCI Registry)

“…Prior studies showed that lower preprocedural hemoglobin and impaired renal function are associated with worse clinical outcomes after PCI [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. These two factors are crucial for precise risk assessment for adverse outcomes after PCI, namely, mortality and bleeding [15,16], but the combined effects of anemia and impaired renal function have not been thoroughly investigated, especially in contemporary and large PCI registries.…”

“…The reasons for worse clinical outcomes after PCI in patients with lower hemoglobin and higher creatinine levels are thought to be multifactorial [3,14]. First, the presence of anemia and CKD may be directly associated with the progression of CAD and myocardial ischemia [3,10,14].…”

“…The reasons for worse clinical outcomes after PCI in patients with lower hemoglobin and higher creatinine levels are thought to be multifactorial [3,14]. First, the presence of anemia and CKD may be directly associated with the progression of CAD and myocardial ischemia [3,10,14]. Second, as shown in this study, patients with anemia and CKD tend to be older and have more comorbidities such as hypertension, diabetes mellitus, heart failure, peripheral artery disease, and chronic obstructive pulmonary disease than those without [1][2][3][4][6][7][8][9][10][11][12][13][14][18][19][20][21].…”

“…Patients who were <20 or >100 years of age and those with missing data for preprocedural hemoglobin and/or serum creatinine levels and in-hospital outcomes were excluded. Because the serum creatinine levels in dialysis patients fluctuate before and after hemodialysis, and it is clear that patients with advanced chronic kidney disease (CKD) have worse clinical outcomes after PCI than those without [8][9][10][11][12][13][14], in this study we excluded dialysis patients and patients with baseline serum creatinine levels >3.0 mg/dL. In addition, baseline hemoglobin levels <3.0 g/dL or >20.0 g/dL were also excluded as potential outliers.…”

“…Previous studies reported that preprocedural anemia [1][2][3][4][5][6][7] and impaired renal function [8][9][10][11][12][13][14] are both associated with adverse outcomes such as death and bleeding after percutaneous coronary intervention (PCI). Indeed, most of the established risk prediction models for mortality and bleeding include these two factors as dependent variables [15,16].…”