Chronic kidney disease and the risk of stent thrombosis after percutaneous coronary intervention with drug‐eluting stents

Ming, Yu; Zhou, Yujie; Wang, Zhijian; Shi, Dongmei; Liu, Yuyang; Zhao, Yan; Gao, Fei; Yang, Shiwei; Jia, Dongyu

doi:10.1002/ccd.23464

Cited by 31 publications

(20 citation statements)

References 52 publications

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“…As reported elsewhere, the CKD-EPI equation staged fewer patients to CKD than MDRD formula [21] and in our population produced a predicting ability for stent thrombosis events, posing a possible value for implementation in risk stratification algorithms. Our findings are in accordance to other studies [22] expressing the hypothesis that renal impairment is a significant risk factor for ST.…”

Section: Discussionsupporting

confidence: 96%

Late differences in outcomes of patients with stable angina and an isolated lesion in the proximal left anterior descending artery treated with new-generation drug-eluting stents

Toutouzas

Patsa

Matsoukis

et al. 2015

International Journal of Cardiology

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Section: Discussionsupporting

confidence: 96%

Late differences in outcomes of patients with stable angina and an isolated lesion in the proximal left anterior descending artery treated with new-generation drug-eluting stents

Toutouzas

Patsa

Matsoukis

et al. 2015

International Journal of Cardiology

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“…Patients with CKD more often had a multivessel disease and PCI of saphenous vein graft as compared to patients with a normal eGFR, which is in keeping with previous observations [11,14,16,23]. In addition to that, CKD patients more often had ST at culprit lesion in our group, which confirmed results of Miao et al [24]. Data from other studies showed that PCI with DES-II in a real-world population is associated with lower risk of clinically meaningful restenosis, ST, and a lower risk of death compared with DES-I [25,26].…”

Section: Discussionsupporting

confidence: 82%

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

et al. 2016

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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.

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“…The higher prevalence of high platelet reactivity in the CKD population might be another potential explanation for the higher incidence of nonfatal target vessel MI in the CR group than in the IR group among CKD patients. This finding suggests that excessive PCI with DES implantation might be associated with procedure‐related or stent‐related long‐term adverse outcomes rather than the benefit of revascularization as previous studies have suggested 1, 33, 34…”

Section: Discussionmentioning

confidence: 67%

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Kim

Lee

Choi

et al. 2018

JAHA

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BackgroundThere are limited data regarding the prognostic impact of angiographic complete revascularization (CR) in patients with chronic kidney disease (CKD). We sought to investigate the differential prognostic impact of angiographic CR over incomplete revascularization (IR), according to the presence of CKD in the drug‐eluting stent era.Methods and ResultsBetween 2003 and 2011 at Samsung Medical Center, consecutive patients with multivessel disease were stratified by the presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2) and classified according to angiographic CR (residual SYNTAX score=0) or IR. Clinical outcomes were compared between angiographic CR and IR, stratified by the presence of CKD. Primary outcome was patient‐oriented composite outcomes (POCO, a composite of all‐cause death, myocardial infarction, any revascularization) at 3 years. Inverse probability weighting was performed between the CR and IR groups. A total of 3224 patients were eligible for analysis: 2295 without CKD; 929 with CKD. Among non‐CKD patients, angiographic CR showed a significantly lower risk of POCO than IR (17.2% versus 21.7%, adjusted hazard ratio 0.76, 95% confidence interval, 0.62–0.95, P=0.014), mainly driven by a significantly lower risk of any revascularization. Among CKD patients, however, angiographic CR was associated with a significantly higher risk of POCO than IR (37.7% versus 28.4%, adjusted hazard ratio 1.42, 95% confidence interval, 1.08%–1.85%, P=0.011), mainly driven by a significantly higher risk of nonfatal target vessel myocardial infarction.ConclusionsAngiographic CR was associated with reduced risk of POCO than IR in patients without CKD; however, it was associated with a significantly higher risk of POCO and nonfatal myocardial infarction in CKD patients.

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Chronic kidney disease and the risk of stent thrombosis after percutaneous coronary intervention with drug‐eluting stents

Abstract: CKD is significantly associated with increased incidence of 1-year definite or probable ST in patients undergoing PCI with DES.

Cited by 31 publications

References 52 publications

Late differences in outcomes of patients with stable angina and an isolated lesion in the proximal left anterior descending artery treated with new-generation drug-eluting stents

Late differences in outcomes of patients with stable angina and an isolated lesion in the proximal left anterior descending artery treated with new-generation drug-eluting stents

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

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

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