Impact of Mild-to-Moderate Chronic Kidney Disease on One Year Outcomes after Percutaneous Coronary Intervention

Abstract

Background/Aim: Patients with severe chronic kidney disease (CKD) have a higher risk of adverse events after percutaneous coronary intervention (PCI). There is conflicting evidence regarding the benefit of drug-eluting stents (DES) in patients with CKD. This study is aimed at assessing the effect of mild-to-moderate CKD on PCI outcomes, and determining if DES reduce adverse events amongst these patients. Method: We used our PCI database to determine demographic, procedural and outcome variables for 1960 consecutive patients (October 2009-October 2012). Kidney function was measured by the estimated glomerular filtration rate (eGFR - CKD-Epidemiology Collaboration creatinine based). Multivariate analysis was performed to determine independent variables associated with mortality and major adverse cardiovascular events (MACE). Results: The independent variables, predictive of 12-month mortality in PCI patients, were: age >64 years (hazard ratio [HR] 3.10 [95% CI 1.73-5.55], p < 0.001), 3-vessel disease (HR 1.72 [95% CI 1.10-2.68], p = 0.016) and CKD stage. Compared to stage 1 CKD (eGFR >89), HR of death increased in a progressive pattern below eGFR <75: eGFR 60-74, HR 2.40 (95% CI 1.2-4.78), p = 0.013, eGFR 45-59, HR 3.27 (95% CI 1.55-6.9), p = 0.002, eGFR 30-44, HR 4.10 (95% CI 1.82-9.24), p = 0.001, eGFR <30, HR 7.97 (95% CI 3.65-17.40), p < 0.001. In patients with eGFR <75, multivariate analysis demonstrated that DES use was an independent predictor of lower MACE (HR BMS vs. DES 1.8, p = 0.0044). Conclusion: Age, severity of CKD and 3-vessel disease were independent predictors of mortality following PCI. The mortality risk in CKD patients increased progressively with eGFR <75. The use of DES was associated with a lower rate of MACE in CKD patients with eGFR <75.

One-year clinical outcomes in patients with renal insufficiency after contemporary PCI: data from a multicenter registry

“…There is a linear relationship between cardiovascular mortality and decreasing GFR with the highest cardiovascular morbidity and mortality in patients on HD [5][6][7][8]. Patients with CKD on HD exhibit a high risk for cardiovascular events as well as an altered coagulation with both increased thrombotic and bleeding risks, which may be caused by denser clot structures [33].…”

“…Chronic kidney disease (CKD) is highly prevalent, affecting more than 1.5 million patients in Europe and the USA and represents one of the most frequent comorbidities in patients with coronary artery disease (CAD) [1][2][3][4]. There is a linear relationship between cardiovascular mortality and impaired glomerular filtration rate (GFR) [5][6][7][8]. Severe and diffuse CAD is prevalent in patients with CKD [5][6][7][8][9][10].…”

“…There is a linear relationship between cardiovascular mortality and impaired glomerular filtration rate (GFR) [5][6][7][8]. Severe and diffuse CAD is prevalent in patients with CKD [5][6][7][8][9][10]. In those patients, revascularization options include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) [11][12][13].…”

“…In those patients, revascularization options include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) [11][12][13]. Adverse event rates following PCI and CABG were significantly higher in CKD patients when compared to patients with normal renal function [5][6][7][8][14][15][16]. Moreover, these patients differ from the general population concerning symptoms of acute cardiac events, poor access sites, complex vascular lesions, and a higher rate of complications [8,[13][14][15][16][17][18].…”

“…Adverse event rates following PCI and CABG were significantly higher in CKD patients when compared to patients with normal renal function [5][6][7][8][14][15][16]. Moreover, these patients differ from the general population concerning symptoms of acute cardiac events, poor access sites, complex vascular lesions, and a higher rate of complications [8,[13][14][15][16][17][18]. However, patients with CKD are under-represented in clinical studies on revascularization, and, thus, knowledge on performance of PCI using newest-generation drug-eluting stents (DES) is limited [9,13].…”