Dose‐dependent effect of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention

Abstract

Objective To determine the risk prediction of various degrees of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention (PCI). Background Patients with chronic kidney disease (CKD) are at high risk of all‐cause mortality after PCI. However, there are less data of various degrees of impaired renal function to predict those risks. Methods This was a subgroup analysis of nationwide PCI registry of 22 045 patients. Patients were classified into six CKD stages according to preprocedure estimated glomerular filtration rate (eGFR) (ml/min/1.73 m2): I (≥90), II (60−89), III (30−59), IV (15−29), or V (<15) without or with dialysis. Baseline clinical and angiographic characteristics were compared among patients in each stage. One‐year all‐cause mortality was reported with risk prediction based on CKD stages and other risk factors. Results Patients with CKD stage I−V without and with on dialysis were found in 26.9%, 40.8%, 23.2%, 3.9%, 1.5%, and 3.7%, respectively. PCI procedural success and complication rates ranged from 94.0% to 96.2% and 2.8% to 6.1%, respectively. One‐year overall survival among CKD stages I−V was 96.3%, 93.1%, 84.4%, 65.2%, 68.0%, and 69.4%, respectively (p < .001 by log‐rank test). After adjusting covariables, the hazard ratios of all‐cause mortality for CKD stages II−V as compared to stage I by multivariate Cox regression analysis were 1.5, 2.6, 5.3, 5.9, and 7.0, respectively, (p < .001). Conclusion Among patients undergoing PCI, lower preprocedure eGFR is associated in a dose‐dependent effect with decreased 1‐year survival. This finding may be useful for risk classification and to guide decision‐making.

The triglyceride-glucose index predicts 1-year major adverse cardiovascular events in end-stage renal disease patients with coronary artery disease

“…Cardiovascular disease is the main reason for illness and death in this group of patients, and CAD plays a significant role [1,27]. Given distinctive changes in lipid and glucose metabolism, it may not be appropriate to extrapolate findings from CAD patients with normal kidney function to patients with ESRD and CAD [3,4,[17][18][19][20][21]. Assessing the importance of the TyG index in risk stratification in this group of patients is of great therapeutic significance, considering the increasing number of individuals with ESRD and CAD, as well as the potential prognostic significance of the TyG index.…”

“…Cardiovascular events are significantly more likely to occur in patients with end-stage renal disease (ESRD), who are considered a highly susceptible subset of coronary artery disease (CAD) [ 1 , 2 ]. The risk of one-year major adverse cardiovascular events (MACE) for these patients is more than five times greater than that of patients without ESRD [ 3 , 4 ]. Notably, the excess risk in patients with ESRD and CAD cannot be solely attributed to traditional cardiovascular risk factors [ 1 , 5 ].…”

Higher Inpatient mortality following Percutaneous Coronary Intervention in Patients with Advanced Chronic Kidney Disease.

“…As the main results of our study, the history of ACKD remains independently associated with in-hospital death following PCI even after adjusting baseline parameters such as other cardiovascular risk profiles. In many studies, chronic renal failure, especially frequent dialysis, has been declared as a potential risk factor for adverse outcomes of therapeutic interventions in patients with coronary heart disease, especially following revascularization (13)(14)(15)(16)(17). This higher mortality can be explained by the use of contrast material, disorders related to circulating blood volume, thromboembolic disorders related to kidney disease, and significant hemodynamic disorders in the mentioned patients (18)(19)(20).…”

“…In several trials, the presence of underlying chronic kidney disease was considered a major risk factor for long-term poorer outcomes following PCI, such as higher mortality and progression of renal impairment (8)(9), also the impaired renal elimination of antithrombotic drugs exposes these patients to a higher likelihood of bleeding complications (10)(11). During our literature review on databases, we found a small number of studies looking into the impacts of PCI on ACKD patients, Limpijankit and his colleague as one of the few studies in this matter determined one-year survival of PCI among 207 CKD patients stage 4-5 without dialysis and 5 with dialysis was 65.2%, 68.0% and 69.4 respectively (12). Therefore, the outcome of PCI procedures in patients with ACKD still remains uncertain.…”

P2y12 inhibitor monotherapy after 1–3 months dual antiplatelet therapy in patients with coronary artery disease and chronic kidney disease undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials

“…Patients with CAD and chronic kidney disease (CKD) face a higher risk of bleeding and ischemic events, which significantly impacts clinical prognosis ( 9 ). Thus, antiplatelet treatment for these patients requires extra caution to balance the risks of bleeding and ischemia.…”