Long-Term Percutaneous Coronary Intervention Outcomes of Patients with Chronic Kidney Disease in the Era of Second-Generation Drug-Eluting Stents

Abstract

Background: The following registry (Katowice-Zabrze retrospective registry) aimed to assess the influence of a chronic kidney disease (CKD) on long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) using either first-generation (DES-I) or second-generation (DES-II) drug-eluting stents. Methods: The study group consisted of 1,908 consecutive patients, of whom 331 (17.3%) had CKD. CKD was defined as an estimated glomerular filtration rate of <60 mL/min/m². We evaluated the major adverse cardiac and cerebral events (MACCE), i.e., the composite of death, myocardial infarction (MI), stroke, and target vessel revascularization at the 12-month follow-up. Results: CKD patients had a lower left ventricular ejection fraction and more often a history of MI and PCI. Coronary angiography revealed that multivessel coronary artery disease, intracoronary thrombus, and extensive calcifications were more frequent in patients with CKD. However, the SYNTAX score did not vary between patients with or without CKD. There was a higher rate of in-hospital bleedings requiring blood transfusion in patients with CKD. At the 1-year follow-up, MACCE (17.8 vs. 12.6%, HR = 1.46 [95% CI 1.05-2.03], p = 0.009) and death (8.4 vs. 2.3%, HR = 3.9 [95% CI 2.0-7.5], p < 0.001) were more often observed in CKD patients. Multivariable Cox analysis revealed that CKD was an independent risk predictor of death after PCI at the 1-year follow-up (HR = 2.1 [95% CI 1.2-3.6], p = 0.004). In comparison to DES-I, the use of DES-II did not decrease the adverse effect of CKD on MACCE. Conclusion: CKD patients had an increased risk of in-hospital bleeding requiring blood transfusion and a higher risk of MACCE and death at the 12-month follow-up. The use of second-generation DES did not improve clinical outcomes in patients with CKD at the 12-month follow-up.

How does clinical profile and outcome differ in patients with Chronic Kidney Disease undergoing percutaneous coronary revascularization according to the severity of CKD? – CHANNEL Study

“…Previous studies have shown that renal impairment is a significant prognostic predictor of mortality in patients with coronary artery disease. 14 , 15 …”

A focused review on optimal coronary revascularisation in patients with chronic kidney disease

“…The benefits of second-over first-generation DES in the CKD population are unclear, with a retrospective analysis failing to demonstrate mortality benefits with the use of second-generation DES 18 , probably due to systemic factors which are recognised to worsen oxidative stress and systemic inflammation independently 19 . Other contributing factors include left ventricular dysfunction (LVD) which is associated with adverse outcomes post PCI 20 .…”

Association Between Phosphate and Long-term Outcome in CAD Patients Underwent Coronary Intervention

“…However, the prognosis of patients with CKD undergoing PCI is unsatisfactory. [9][10][11][12] Previous studies have shown that increased serum levels of phosphate were associated with poor revascularization outcomes. 13 However, they only investigated patients undergoing regular dialysis with a short follow-up period.…”