One-year clinical outcomes in patients with renal insufficiency after contemporary PCI: data from a multicenter registry

Abstract

Background Chronic kidney disease (CKD) is highly prevalent in patients with coronary artery disease (CAD). Objective The outcome following revascularization using contemporary technologies (new-generation abluminal sirolimuseluting stents with thin struts) in patients with CKD (i.e., glomerular filtration rate of < 60 mL/min/1.73m 2 ) and in patients with hemodialysis (HD) is unknown. Methods e-Ultimaster is a prospective, single-arm, multi-center registry with clinical follow-up at 3 months and 1 year. Results A total of 19,475 patients were enrolled, including 1466 patients with CKD, with 167 undergoing HD. Patients with CKD had a higher prevalence of overall comorbidities, multiple/small vessel disease (≤ 2.75 mm), bifurcation lesions, and more often left main artery treatments (all p < 0.0001) when compared with patients with normal renal function (reference). CKD patients had a higher risk of target lesion failure (unadjusted OR, 2.51 [95% CI 2.04-3.08]), target vessel failure (OR, 2.44 [95% CI 2.01-2.96]), patient-oriented composite end point (OR, 2.19 [95% CI 1.87-2.56]), and major adverse cardiovascular events (OR, 2.34 [95% CI 1.93-2.83, p for all < 0.0001]) as reference. The rates of target lesion revascularization (OR, 1.17 [95% CI 0.79-1.73], p = 0.44) were not different. Bleeding complications were more frequently observed in CKD than in the reference (all p < 0.0001). Conclusion In this worldwide registry, CKD patients presented with more comorbidities and more complex lesions when compared with the reference population. They experienced higher rate of adverse events at 1-year follow-up.

Cardiovascular outcomes following percutaneous coronary intervention with drug-eluting balloons in chronic kidney disease: a retrospective analysis

“…CKD patients are more prone to IHD and tend to have poorer outcomes following revascularization with PCI or coronary artery bypass surgery [8,22]. Even in the era of PCI with the newer generation of DES, and with wellbalanced guideline-based medical therapy, adverse cardiovascular outcomes are more frequent in those with than without CKD [10,19,23]. Additionally, higher rates of MACE were recently reported in patients on hemodialysis who underwent PCI with DEB compared to patients not on hemodialysis [24].…”

Small vessel coronary artery disease: How small can we go with myocardial revascularization?

“…Depending on the applied definition, the prevalence of small vessel disease (SVD) reaches roughly 1/3 of patients with symptomatic coronary artery disease (CAD) [1,2], especially patients with chronic kidney disease (CKD) [3], diabetes mellitus [4], and active smokers [5][6][7].…”

“…The clinical profile of SVD patients, as well as higher rate of short-and long-term procedural complications, translates into poor long-term outcomes [3,5]. Despite the use of new-generation drug-eluting stents (DES), an accumulating body of evidence suggests that PCI of coronary arteries < 2.5 mm is associated with a high rate of target lesion failure or cardiovascular death [5].…”

Sex-specific differences and long-term outcome of patients with coronary artery disease and chronic kidney disease: the Coronary Artery Disease and Renal Failure (CAD-REF) Registry

“…Not surprisingly, overall-mortality was higher in patients with more advanced CKD than in patients without CKD. Several studies with follow-up periods of 1–5 years support this observation: a very recent international, multicenter registry evaluation on the outcome after contemporary PCI in patients with CAD and renal insufficiency reported that one of the most powerful parameters for adverse outcome, namely major adverse cardiovascular events including cardiac death as well as a patient-oriented composite endpoint including all-cause death, was the presence of CKD and dialysis-dependent CKD [ 36 ]. Other predictors were age, diabetes mellitus, previous MI, and smoking, all in good accordance with our findings.…”