The impact of renal function on the long-term clinical course of patients who underwent percutaneous coronary intervention
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Michail I Papafaklis1, Katerina K Naka, Nikos D Papamichael
1Michaelideion Cardiac Centre, University of Ioannina, Ioannina, Greece.
Insights
Reduced kidney function significantly increases long-term mortality after percutaneous coronary intervention (PCI). Even mild chronic kidney disease (CKD) poses a higher risk for cardiac and all-cause death post-PCI.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Chronic kidney disease (CKD) is linked to higher mortality after percutaneous coronary intervention (PCI).
- Understanding long-term outcomes in CKD patients undergoing PCI is crucial for risk stratification.
Purpose of the Study:
- To assess the impact of varying kidney function levels on long-term clinical outcomes after successful PCI.
- To investigate the relationship between glomerular filtration rate (GFR) and major adverse cardiac events (MACE) beyond 5 years.
Main Methods:
- Retrospective analysis of 371 non-dialysis patients undergoing successful PCI.
- Stratification based on baseline estimated glomerular filtration rate (eGFR): normal/mildly impaired (≥60 ml/min/1.73 m²) vs. CKD (<60 ml/min/1.73 m²).
- Multivariate Cox regression analysis to determine the independent effect of eGFR on long-term mortality and MACE.
Main Results:
- Nine-year all-cause and cardiac mortality were substantially higher in the CKD group (45.9% vs. 10.6% and 35.4% vs. 7.1%, respectively; P < 0.0001).
- No significant differences were observed in repeat revascularization or nonfatal myocardial infarction rates.
- Multivariate analysis confirmed that lower eGFR independently predicts increased long-term all-cause and cardiac mortality.
Conclusions:
- Kidney function level is a critical determinant of long-term mortality following successful PCI.
- Even mild reductions in GFR are associated with significantly worse long-term survival after PCI.
Objectives:
To determine the impact of the level of kidney function on the extended (>5 years) long-term clinical course of patients undergoing percutaneous coronary intervention (PCI).
Background:
Chronic kidney disease (CKD) has been significantly associated with an increased in-hospital and 1-year mortality following PCI.
Methods:
In this single-centre retrospective study, glomerular filtration rate (GFR) at baseline was estimated in 371 patients not on dialysis, who underwent successful PCI between mid-1995 and mid-1999. Baseline demographic and angiographic characteristics, and long-term major adverse cardiac events and symptoms were compared for patients with GFR > or =60 ml/min/1.73 m(2) (normal or mildly impaired renal function) and GFR > or = 60 ml/ min/1.73 m(2) (CKD). The independent effect of GFR, modelled both as a categorical and a continuous variable, on long-term clinical outcomes was also investigated using multivariate Cox regression analysis.
Results:
Nine-year all-cause and cardiac mortality rates were significantly higher in the CKD group (45.9% vs. 10.6%, P < 0.0001 and 35.4% vs. 7.1%, P < 0.0001 respectively), while there was no difference in the repeat revascularization (P = 0.27) and nonfatal Q-wave myocardial infarction (P = 0.74) rates. Multivariate analysis demonstrated an independent impact of the level of GFR on long-term mortality; adjusted 9-year all-cause and cardiac mortality increased by approximately 16% and 11%, respectively for a decrease of GFR from 120 to 60 ml/min/1.73 m(2) and by approximately 14% and 9%, respectively for a decrease of GFR from 60 to 30 ml/min/1.73 m(2).
Conclusions:
The level of renal function is a strong determinant of long-term all-cause and cardiac mortality after successful PCI.
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