The impact of renal function on the long‐term clinical course of patients who underwent percutaneous coronary intervention

Papafaklis, Michail I.; Naka, Katerina K.; Papamichael, Nikos; Kolios, George; Sioros, Lampros; Sclerou, Vassiliki; Katsouras, Christos S.; Michalis, Lampros K.

doi:10.1002/ccd.20874

Cited by 15 publications

(4 citation statements)

References 54 publications

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“…33 However, some earlier reports indicated that there was no difference in the repeat revascularization rate between the chronic kidney disease group and the normal renal function group. 34,35 In this study, the rates of TLR were also similar among the four subgroups despite the reduced renal function. There are some probable explanations.…”

Section: Clinical Outcomessupporting

confidence: 60%

Impact of reduced renal function on prognosis in Japanese patients with coronary artery disease: a prospective cohort of Shinken Database 2007

et al. 2009

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Patients with coronary artery disease (CAD) frequently have impaired renal function, but the prevalence and influence of renal dysfunction on their prognosis in Japan remain uncertain. With a prospective study comprising all the new patients who had visited our hospital between 2004 and 2007 (n¼6562), we investigated the prevalence of renal dysfunction and its influence on the prognosis of CAD patients. The glomerular filtration rate (GFR) was calculated by using the GFR equation used for the Japanese population. Of those, 797 patients with CAD and blood tests available were analyzed (median follow-up periods of 693 days). Patients were further classified into four subgroups according to estimated GFR value (eGFR): normal (90peGFR, 12.2%), mildly impaired (60peGFRo90, 58.3%), moderately impaired (30peGFRo60, 23.6%) and severely impaired renal function (eGFRo30, 5.9%). The 2-year survival and cardiovascular event (cardiac death, nonfatal myocardial infarction or readmission for heart failure)-free rates were significantly different among the four subgroups: 98.9, 97.7, 89.3 vs. 67.8%, respectively (Po0.001 for trend), and 100, 98.8, 89.0 vs. 70.0%, respectively (Po0.001 for trend). The age-and gender-adjusted mortality increased significantly in moderately impaired (hazard ratio (HR) 3.1, 95% confidence interval (CI) 1.383-7.017) and in severely impaired subgroups (HR 10.1, 95% CI 4.244-24.178) compared with those with eGFR of 60 or more. After adjustment for baseline differences, eGFR was independently associated with death and cardiovascular events (HR 0.983 and 0.981, 95% CI 0.968-0.998 and 0.965-0.998, respectively). In conclusion, our study identified the prevalence and association of eGFR with prognosis in Japanese patients with CAD, suggesting that strict care for not only CAD but also renal dysfunction is needed for further prevention of cardiovascular events.

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Section: Clinical Outcomessupporting

confidence: 60%

Impact of reduced renal function on prognosis in Japanese patients with coronary artery disease: a prospective cohort of Shinken Database 2007

et al. 2009

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“…Among a relatively large, representative cohort of patients with ESRD treated with PCI using DES, long‐term freedom from MACE and survival were generally poor compared with matched control patients without ESRD. Nearly two‐thirds of ESRD patients experienced MACE and less than half of ESRD patients survived 3 years after PCI with DES, a finding consistent with prior studies 9,16‐19 . We developed risk models for both MACE and mortality among patients with ESRD undergoing PCI, both with good predictive capacity (C‐indices of 0.65 and 0.66, respectively).…”

Section: Discussionsupporting

confidence: 78%

Successful modeling of long term outcomes in end‐stage renal disease patients undergoing percutaneous coronary intervention with drug‐eluting stents

Dunn

Huded

Raymond

et al. 2021

Cathet Cardio Intervent

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Objectives The objective of this study is to identify and model risk factors for major adverse cardiac events (MACE) and all‐cause mortality among patients with ESRD treated with PCI using DES. Background Patients with end‐stage renal disease (ESRD) have poor long‐term outcomes after percutaneous coronary intervention (PCI) compared with non‐ESRD patients. However, there is a paucity of literature regarding risk factors associated with outcomes of ESRD patients after PCI with drug‐eluding stents (DES). Methods This retrospective cohort study includes all patients with ESRD who underwent first‐time PCI with DES at a single, high‐volume hospital between 1/1/2005 and 12/31/2015, with follow‐up through 9/1/2019. Primary outcomes were MACE (cardiac death, myocardial infarction, or unplanned revascularization) and all‐cause mortality. Results Five‐year MACE was 83.0% and five‐year morality was 77.9% in patients with ESRD (n = 285). Among ESRD patients, factors independently associated with MACE were C‐reactive peptide level, SYNTAX score, peripheral vascular occlusive disease, hemoglobin, and treatment of a restenotic lesion (c‐index = 0.66). Factors independently associated with mortality in ESRD patients were age, SYNTAX score, non‐use of statins at baseline, insulin‐dependent diabetes, chronic obstructive pulmonary disease (COPD), peripheral vascular occlusive disease, and platelet count (c‐index = 0.65). Conclusions Despite relatively poor 1‐and 5‐year outcomes among ESRD patients after PCI, risk of MACE and mortality among this cohort can be successfully modelled, which meaningfully informs clinicians regarding management of ESRD patients with coronary artery disease (CAD). Further investigations are necessary to determine whether or not outcomes might be improved through risk profile modification.

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“…Furthermore, renal insufficiency is an independent predictor of increased in-hospital morbidity and mortality after PCI with stent implantation (33). Even after successful PCI, CKD was associated with increased short-term and long-term mortality (19, 34). According to our data and those of others, eGFR is a strong prognostic marker independent of underlying severity of CAD in patients with cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

The Association between Kidney Function, Coronary Artery Disease, and Clinical Outcome in Patients Undergoing Coronary Angiography

Kim²,

Song³

et al. 2009

J Korean Med Sci

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To characterize the association between chronic kidney disease (CKD), mortality, severity of coronary artery disease (CAD), treatment modality of CAD, and type of coronary stents among patients undergoing coronary angiography (CAG), we retrospectively reviewed the electronic medical records of the patients who underwent CAG at Seoul National University Bundang Hospital in Korea between May 2003 and January 2006. CKD was staged using an estimated glomerular filtration rate (eGFR) from the creatinine value prior to CAG. There were 3,637 patients included. The presence of CAD was 48% in CKD stage 1, 61% in stage 2, 73% in stage 3, 87% in stage 4, and 81% in stage 5. Survival rate gradually diminished for patients with decreasing renal function. No significant differences in all-cause and cardiac mortality were observed by medical treatment, PCI or CABG, in CKD patients with an eGFR less than 60 mL/min/1.73 m2. CKD patients with drug-eluting stents showed significantly lower all-cause mortality (5.4% vs. 13.3%) and incidence of myocardial infarction (1.7% vs. 10%) than those with bare metal stents. In conclusion, an eGFR is a strong independent prognostic marker among patients undergoing CAG and the severity of CAD increases progressively with worsening renal function.

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The impact of renal function on the long‐term clinical course of patients who underwent percutaneous coronary intervention

Abstract: The level of renal function is a strong determinant of long-term all-cause and cardiac mortality after successful PCI.

Cited by 15 publications

References 54 publications

Impact of reduced renal function on prognosis in Japanese patients with coronary artery disease: a prospective cohort of Shinken Database 2007

Impact of reduced renal function on prognosis in Japanese patients with coronary artery disease: a prospective cohort of Shinken Database 2007

Successful modeling of long term outcomes in end‐stage renal disease patients undergoing percutaneous coronary intervention with drug‐eluting stents

The Association between Kidney Function, Coronary Artery Disease, and Clinical Outcome in Patients Undergoing Coronary Angiography

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