Chronic kidney disease and diabetes associated with long-term outcomes in patients receiving percutaneous coronary intervention

Abstract

BackgroundThe effect of diabetes mellitus (DM) and chronic kidney disease (CKD) on long-term outcomes in patients receiving percutaneous coronary intervention (PCI) is unclear.MethodsA total of 1394 patients who underwent PCI were prospectively enrolled and divided into 4 groups according to the presence or absence of DM or CKD. Baseline characteristics, risk factors, medications, and angiographic findings were compared. Determinants of long-term outcomes in patients undergoing PCI were analyzed.ResultsPatients with DM and CKD had the highest all-cause mortality and cardiovascular mortality (both P < 0.01) but there were no differences existed in myocardial infarction (MI) or repeated PCI among the 4 groups (P = 0.19, P = 0.87, respectively). Patients with DM and CKD had the lowest even-free rate of all-cause mortality, cardiovascular mortality, MI, and repeated PCI (P < 0.001, P < 0.001, P < 0.001, and P = 0.002, respectively). In the Cox proportional hazard model, patients with both DM and CKD had the highest risk of all-cause mortality (HR: 3.25, 95% CI: 1.85–5.59), cardiovascular mortality (HR: 3.58, 95% CI: 1.97–6.49), MI (HR: 2.43, 95% CI: 1.23–4.08), and repeated PCI (HR: 1.79, 95% CI: 1.33–2.41). Patients with CKD alone had the second highest risk of all-cause mortality (HR: 2.04, 95% CI: 1.15–3.63), cardiovascular mortality (HR: 2.13, 95% CI: 1.13–4.01), and repeated PCI (HR: 1.47, 95% CI: 1.09–1.97).ConclusionsDM and CKD had additive effect on adverse long-term outcomes in patients receiving PCI; CKD was a more significant adverse predictor than DM.

Influence of hypercholesterolemia and diabetes on long-term outcome in patients with stable coronary artery disease receiving percutaneous coronary intervention

“…This result is in contrast to a previous study, which observed a significantly higher risk of developing multivessel disease in patients with both DM and CKD, as compared with patients with DM alone. [21] DM seemed to increase the risk of developing multivessel disease in patients with hypercholesterolemia, but hypercholesterolemia seemed not to increase this risk in patients with DM. Moreover, the 4 groups did not differ in terms of treated number of vessels and lesions; thus, whether with hypercholesterolemia or not, the presence of multivessel disease and high SYNTAX score in DM patients may affect long-term mortality.…”

Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life)

“…From our Cox multivariate analysis, regardless of age, two important comorbidities emerge as predictors of all‐cause death: diabetes mellitus and kidney failure. Previous studies 44‐46 have quantified a minimum of twofold increase in the mortality rate in patients with these comorbidities. Intensive glycemic, lipid, and blood pressure control, in addition to prehydration with normal saline at the time of procedure, remain the only methods of proven efficacy to improve outcomes 46,47 …”

Hypertension and chronic kidney disease affect long-term outcomes in patients with stable coronary artery disease receiving percutaneous coronary intervention

“…In contrast, in a recent study, DM and CKD had an additive effect on adverse long-term outcomes in patients receiving PCI. The presence of CKD seemed to predict a poorer outcome than did DM 12 .…”