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Published on: June 12, 2021
Are patients with renal failure good candidates for percutaneous coronary revascularization in the new device era?
M H Rubenstein1, L C Harrell, B V Sheynberg
1Cardiac Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
Insights
Patients with renal failure undergoing percutaneous coronary intervention have higher risks but improved outcomes with new devices. Stenting and debulking techniques enhance success rates for these complex patients.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Patients with end-stage renal disease (ESRD) face challenges with conventional balloon angioplasty.
- This includes reduced procedural success and increased complication rates.
Purpose of the Study:
- To evaluate immediate and long-term outcomes of percutaneous coronary intervention (PCI) in patients with varying degrees of renal failure.
- To assess the impact of modern devices on these outcomes.
Main Methods:
- A comparative study of 362 renal failure patients (creatinine >1.5 mg/dL) and 2972 patients with normal renal function.
- Data collected between 1994 and 1997, comparing immediate and long-term outcomes.
- Statistical analysis included logistic regression and Cox regression.
Main Results:
- Renal failure patients were older with more comorbidities, showing reduced procedural success (89.5% vs 92.9%) and higher in-hospital major adverse cardiac events (MACEs) (10.8% vs 1.8%).
- Renal failure was an independent predictor of MACEs (OR, 3.41).
- Long-term follow-up revealed lower survival (27.7% vs 6.1%) and greater MACE rates (51% vs 33%) in renal failure patients. Dialysis and non-dialysis patients had similar outcomes.
Conclusions:
- Despite increased risks, PCI in renal failure patients can achieve high procedural success rates with modern devices.
- Stenting and debulking techniques significantly improve both immediate and long-term outcomes in this population.
- Renal failure remains a significant predictor of adverse cardiac events post-PCI.
Background:
Patients with end-stage renal disease undergoing conventional balloon angioplasty have reduced procedural success and increased complication rates. This study was designed to determine the immediate and long-term outcomes of patients with varying degrees of renal failure undergoing percutaneous coronary intervention in the current device era.
Methods And Results:
We compared the immediate and long-term outcomes of 362 renal failure patients (creatinine >1.5 mg/dL) with those of 2972 patients with normal renal function who underwent percutaneous coronary intervention between 1994 and 1997. Patients with renal failure were older and had more associated comorbidities. They had reduced procedural success (89.5% versus 92.9%, P:=0.007) and greater in-hospital combined major event (death, Q-wave myocardial infarction, emergent CABG; 10.8% versus 1.8%; P:<0.0001) rates. Renal failure was an independent predictor of major adverse cardiac events (MACEs) (OR, 3.41; 95% CI, 1.84 to 6.22; P:<0.00001). Logistic regression analysis identified shock, peripheral vascular disease, balloon angioplasty strategy, and unstable angina as independent predictors of in-hospital MACEs in the renal group. Compared with 362 age- and sex-matched patients selected from the control group, patients with renal failure had a lower survival rate (27.7% versus 6.1%, P:<0.0001) and a greater MACE rate (51% versus 33%, P:<0.001) at long-term follow-up. Cox regression analysis identified age and PTCA strategy as independent predictors of long-term MACEs in the renal group. Finally, within the renal failure population, the dialysis and nondialysis patients experienced remarkably similar immediate and long-term outcomes.
Conclusions:
Although patients with renal failure can be treated with a high procedural success rate in the new device era, they have an increased rate of major events both in hospital and at long-term follow-up. Nevertheless, utilization of stenting and debulking techniques improves immediate and long-term outcomes.
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