Outcomes of STEMI patients with chronic kidney disease treated with percutaneous coronary intervention: the Malaysian National Cardiovascular Disease Database – Percutaneous Coronary Intervention (NCVD-PCI) registry data from 2007 to 2014

Abstract

BackgroundPatients with renal impairment often left out from most major clinical trials assessing the optimal treatment for ST-elevation myocardial infarction (STEMI). Large body of evidence from various cardiovascular registries reflecting more ‘real-world’ experience might contribute to the knowledge on how best to treat this special cohort. We aim to analyze the outcomes of Malaysian STEMI patients with renal impairment treated with coronary angioplasty.MethodsUtilizing the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD-PCI) registry data from 2007 to 2014, STEMI patients treated with percutaneous coronary intervention (PCI) were stratified into presence (GFR < 60 mls/min/1.73m2) or absence (GFR ≥ 60 mls/min/1.73m2) of chronic kidney disease (CKD). Patient’s demographics, extent of coronary artery disease, procedural data, discharge medications, short (in-hospital) and long (1 year) term outcomes were critically assessed.ResultsA total of 6563 patients were included in the final analysis. STEMI CKD cohort was predominantly male (80%) with mean age of 61.02 ± 9.95 years. They had higher cardiovascular risk factors namely diabetes mellitus (54.6%), hypertension (79.2%) and dyslipidemia (68.8%) in contrast to those without CKD. There were notably higher percentage of CKD patients presented with Killip class 3 and 4; 24.9 vs 8.7%. Thrombolytic therapy remained the most commonly instituted treatment regardless the status of kidney function. Furthermore, our STEMI CKD cohort also was more likely to receive less of evidence-based treatment upon discharge. In terms of outcomes, patients with CKD were more likely to develop in-hospital death (OR: 4.55, 95% CI 3.11–6.65), MACE (OR: 3.42, 95% CI 2.39–4.90) and vascular complications (OR: 1.88, 95% CI 0.95–3.7) compared to the non-CKD patients. The risk of death at 1-year post PCI in STEMI CKD patients was also reported to be high (HR: 3.79, 95% CI 2.84–5.07).ConclusionSTEMI and CKD is a deadly combination, proven in our cohort, adding on to the current evidence in the literature. We noted that our STEMI CKD patients tend to be younger than the Caucasian with extremely high prevalence of diabetes mellitus. The poor outcome mainly driven by immediate or short term adverse events peri-procedural, therefore suggesting that more efficient treatment in this special group is imperative.

Temporal trends in treatment strategies and clinical outcomes among patients with advanced chronic kidney disease and ST-elevation myocardial infarctions: results from the Bremen STEMI registry

“…Studies focusing on STEMI-patients with advanced CKD are scarce. A registry analysis from Malaysia showed that STEMI-patients with advanced CKD had a worse prognosis and higher vascular complication-rates than patients with no CKD [ 25 ]. However, primary PCI-rates were comparatively low at 21% with high rescue PCI-rates after failed systemic fibrinolytic therapy at 70%.…”

Risk of perioperative death and sudden cardiac arrest: A study of 113 456 cases from the National Registry of Invasive Cardiology Procedures (ORPKI) for estimation of the perioperative prognosis

“…In that study, chronic renal failure was associated with more common myocardial infarction and a higher risk of death. Between 2007 and 2014, Ismail et al [21] investigated 6563 patients from the Malaysian National Cardiovascular Disease Database -Percutaneous Coronary Intervention (NCVD-PCI). The study showed a higher cardiovascular risk in patients with diabetes (54.6%), hypertension (79.2%), and dyslipidemia (68.8%).…”

Radial versus femoral access percutaneous coronary intervention in patients with acute myocardial infarction: Experience from a Southeast Asian country PCI registry

“…For this study, the data of patients who underwent PCI from 2007 to 2014 in 15 participating hospitals across the country were retrospectively analyzed. The description of methods can also be found in previously published articles generated from this registry (12,13) and in the Annual Report of the NCVD-PCI registry year 2013-2014 (14).…”

“…Consistent with previously published reports from NCVD-PCI registry, our cohort of patients are generally much younger than reports from other parts of the world by approximately 10 years. (12,14)There were significantly more old and female patients subjected to the femoral approach during cardiac catheterization likely because they tend to have difficult and complex vasculatures. In patients with higher BMI and taller, it was more commonly performed via a radial approach.…”