Impact of renal failure on all-cause mortality and other outcomes in patients treated by percutaneous coronary intervention

Loncar, Goran; Barthélémy, Olivier; Berman, Emmanuel; Kernéis, Mathieu; Petroni, Thibault; Payot, Laurent; Choussat, Rémi; Silvain, Johanne; Collet, Jean‐Philippe; Helft, Gérard; Montalescot, Gilles; Feuvre, Claude Le

doi:10.1016/j.acvd.2015.06.001

Cited by 14 publications

(12 citation statements)

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“…Renal dysfunction has been recognized as a prognostic factor in acute coronary syndrome irrespective of whether PCI was performed [8][9][10][11][12][13][14], and the GRACE score incorporates serum creatinine as a major component for risk stratification. However, its role in assessing the thromboembolic risk for AF patients has been debated.…”

Section: Resultsmentioning

confidence: 99%

Impact of chronic kidney disease on the long-term prognosis of patients with atrial fibrillation undergoing coronary stenting

Wang¹,

Ma²,

Zheng³

et al. 2018

biomedicalresearch

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Background: The effect of Chronic Kidney Disease (CKD) on the long-term prognosis of patients with Atrial Fibrillation (AF) undergoing coronary stenting was less studied. Methods: We enrolled 2,511 patients with non-valvular AF undergoing coronary stenting between January 2010 and June 2015 from 12 hospitals in Beijing, China. Results: 22.9% had CKD (creatinine clearance<60 ml/min). Compared to those with preserved renal function, patients with CKD were older, and had the higher prevalence of women, hypertension, previous ischemic stroke, cardiac dysfunction, and anemia. All patients were treated with drug-eluting stents. Dual antiplatelet therapy was the dominant antithrombotic strategy in both groups (96.0% vs. 93.9%, P=0.054). The follow-up duration was 39.5 ± 18.6 months. Complete follow-up data was obtained for 95.3% of this cohort. CKD group had higher incidences of death (19.0% vs. 6.9%, P<0.001), ischemic stroke (5.5% vs. 3.3%, P=0.020), MACCE (a composite of all-cause death, non-fatal myocardial infarction, target vessel revascularization, ischemic stroke and arterial thromboembolism, 28.2% vs. 14.7%, P<0.001) and Bleeding Academic Research Consortium (BARC) ≥ grade 3 (2.4% vs. 0.8%, P=0.003). No significant difference was noted with regard to myocardial infarction and target vessel revascularization. Cox multivariate regression identified CKD as an independent risk factor for allcause death (Hazard ratio (HR): 1.85, 95% CI: 1.37-2.50), MACCE (HR: 1.56, 95% CI: 1.25-1.96) and BARC ≥ 3 bleeding (HR: 3.14, 95% CI: 1.49-6.61), but not for ischemic stroke (HR: 1.10, 95% CI: 0.67-1.79). Conclusion: CKD was independently associated with poor long-term prognosis except for ischemic stroke in patients with AF and coronary stenting.

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Section: Resultsmentioning

confidence: 99%

Impact of chronic kidney disease on the long-term prognosis of patients with atrial fibrillation undergoing coronary stenting

Wang¹,

Ma²,

Zheng³

et al. 2018

biomedicalresearch

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“…An alternative approach used in other fields with a high burden of disease that may be divided into several outcomes that by themselves are relatively rare has been integrating important clinical outcomes into a composite endpoint that can then represent a more comprehensive measure of the overall response to therapy from a safety perspective. Although most studies have been done in the general field of cardiology [ 10 , 13 , 15 , 18 , 19 ], there have been many reports of trials using composite endpoints in infectious diseases (including tuberculosis [ 7 ]) as well as in stroke [ 11 ], diabetes [ 8 ], rheumatoid arthritis [ 20 ], and renal failure [ 6 ], among others. Only one study used a composite endpoint to evaluate the safety of endobronchial valves [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Facing a similar situation, studies in other medically relevant fields have integrated infrequently occurring events into composite endpoints that have proven relevant to the planning of clinical trials and the likely benefit of treatment to patients [ 5 – 9 ]. This is particularly relevant in the field of cardiology, where a composite measure of major adverse cardiac events (MACE) has become a frequent endpoint for therapeutic trials [ 5 , 6 , 10 ]. Composite endpoints have also been used in infectious diseases (including tuberculosis [ 7 ]), in stroke [ 11 ], collagen vascular disease [ 12 ], multiple sclerosis [ 9 ], diabetes [ 8 ], and renal failure [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…This is particularly relevant in the field of cardiology, where a composite measure of major adverse cardiac events (MACE) has become a frequent endpoint for therapeutic trials [ 5 , 6 , 10 ]. Composite endpoints have also been used in infectious diseases (including tuberculosis [ 7 ]), in stroke [ 11 ], collagen vascular disease [ 12 ], multiple sclerosis [ 9 ], diabetes [ 8 ], and renal failure [ 6 ]. In COPD, a composite endpoint for safety in an endobronchial valve trial for emphysema was evaluated [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Defining a COPD composite safety endpoint for demonstrating efficacy in clinical trials: results from the randomized, placebo-controlled UPLIFT® trial

et al. 2016

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BackgroundChronic obstructive pulmonary disease (COPD) clinical trials evaluating hard endpoints (mortality, hospitalized exacerbations) require a large number of subjects and prolonged observational periods. We hypothesized that a composite endpoint of respiratory outcomes (CERO) can help evaluate safety and benefit in COPD trials.MethodsRetrospective analysis of 5992 patients enrolled in the 4-year UPLIFT® trial, a randomized trial of tiotropium versus placebo in patients with moderate-to-severe COPD. Patients were permitted to continue using their usual COPD medications except for other anticholinergics. The CERO included deaths, respiratory failure, hospitalized exacerbations, and trial dropout due to COPD worsening. The incidence rates (IRs) per 100 patient-years and risk ratios (RRs and 95 % CI) were determined at years 1 to 4. The effect of treatments on CERO was similarly assessed. A power analysis helped calculate the sample size needed to achieve outcome differences between treatments.ResultsThe CERO IRs at years 1 to 4 for tiotropium versus placebo were 16, 13, 11, and 11, and 21, 16, 14, and 13, respectively. The RRs of CERO between tiotropium and placebo at the same time points were: RR-year 0.76 (0.67, 0.86), 0.80 (0.72, 0.88), 0.81 (0.74, 0.89), and 0.84 (0.77, 0.92). Using the IRs and RRs, the sample size (alpha = 0.05 two-sided, 90 % power) for studies of 1, 2, 3, and 4 years would be 1546, 1392, 1216, and 1504 per treatment group, respectively, with 575, 810, 930, 1383 required events, respectively, for hypothetical, event-driven studies.ConclusionsA composite endpoint incorporating relatively infrequent serious or significant COPD-related safety outcomes could be useful in clinical trials. In UPLIFT®, CERO events were significantly reduced in patients receiving tiotropium compared with placebo.Trial registrationNCT00144339.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-016-0361-4) contains supplementary material, which is available to authorized users.

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“…Gender and age are major factors that can influence mortality, recent studies demonstrating that mortality is significantly higher in women under the age of 60, while in women older than 60 the existing comorbidities have a significant impact on the outcome of revascularization in the long term [2].…”

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confidence: 98%

Mortality Reduction in Acute Coronary Syndromes — How Far Are We From The Goal?

Benedek

2015

Journal of Cardiovascular Emergencies

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Journal of Cardiovascular Emergencies 2015;1(2):54-55 EDITORIAL Acute coronary syndromes (ACS) are a major challenge for the healthcare in modern medicine. Many efforts are dedicated nowadays to improve the management of ACS and to facilitate an early live-saving intervention of revascularization in these cases [1].Mortality in acute coronary syndromes remains high despite of major intervention in the healthcare systems. Implementation of regional networks dedicated to early diagnosis and treatment of acute myocardial infarction has been proved to be very effective in reduction of mortality in ST-elevation acute myocardial infarction (STE-MI), and the existing networks could also be used in other acute cases, such as non ST-elevation acute myocardial infarction (NSTEMI) or unstable angina (UA). However, in these cases the networks did not show a similar efficacy as in STEMI cases, as they are mainly dedicated to early diagnosis and prompt intervention of STEMI cases, fact that leaves NSTEMI and UA cases somehow neglected.Different factors have been proved to be associated with in-hospital or long-term mortality in ACS. Gender and age are major factors that can influence mortality, recent studies demonstrating that mortality is significantly higher in women under the age of 60, while in women older than 60 the existing comorbidities have a significant impact on the outcome of revascularization in the long term [2].Comorbidities are also strong predictors of death after PCI. Renal failure proved to be strongly associated with a higher risk of death following PCI in acute cases, in a significantly higher extent than in stable coronary artery disease. A recent study demonstrated a double relative risk associated with renal failure in STEMI cases (odds ratio 5.3) as compared with ACS cases (odds ratio 2.1), and with stable coronary artery disease (odds ratio 2.3)[3].Heart failure and cardiogenic shock at presentation have also been proved to be associated with a significantly higher death rate, in both STEMI and NSTEMI cases. At the same time, heart failure is a strong predictor of acute kidney failure in patients with STEMI undergoing primary PCI [4]. Other studies demonstrated the impact of multivessel disease on the outcome of the revascularization procedure, being generally accepted that the presence of a multivessel disease has a negative impact on the survival of ACS patients [5].A study published in this issue demonstrates that in ACS cases, in-hospital mortality is correlated with a multitude of factors, including age, gender, troponin levels, necessity of intra-aortic balloon pump insertion or cardiogenic shock at presentation, multivascular disease, out of hospital resuscitation and the presence of impaired renal function, or comorbidities such as arterial hypertension and diabetes [6]. Interestingly, this study shows that older patients require a longer duration of stay in the intensive care unit as compared with younger patients (73.0 ± 8.5 vs 64.4 ± 11.2, p = 0.007), demonstrating that age is correlated n...

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Impact of renal failure on all-cause mortality and other outcomes in patients treated by percutaneous coronary intervention

Abstract: RF is a stronger independent predictor of death after PCI in STEMI than in ACS or sCAD patients. sCAD-RF and STEMI-nRF patients had similar prognoses.

Cited by 14 publications

References 28 publications

Impact of chronic kidney disease on the long-term prognosis of patients with atrial fibrillation undergoing coronary stenting

Impact of chronic kidney disease on the long-term prognosis of patients with atrial fibrillation undergoing coronary stenting

Defining a COPD composite safety endpoint for demonstrating efficacy in clinical trials: results from the randomized, placebo-controlled UPLIFT® trial

Mortality Reduction in Acute Coronary Syndromes — How Far Are We From The Goal?

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