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Relationship between renal function stage and clinical outcomes after paclitaxel-eluting stent implantation
Yoshiyuki Yazaki1, Raisuke Iijima, Masato Nakamura
1Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan.
Background:
Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). This study aimed to evaluate the relationship between the degree of renal function at baseline and long-term clinical outcomes in coronary artery disease patients who underwent paclitaxel-eluting stent implantation.
Methods:
A total of 336 patients with 400 de-novo lesions underwent PCI between May 2007 and March 2009. The patients were divided into 4 groups: control (glomerular filtration rate (GFR) ≧ 90 ml/min; n = 132); mild CKD (GFR 60-89 ml/min; n = 112); moderate CKD (GFR < 60 ml/min; n = 51); and dialysis (n = 41). All lesions were treated using a paclitaxel-eluting stent. The primary and secondary endpoints were incidences of mortality and major adverse cardiovascular events (MACE) during 2 years after PCI and target vessel revascularization (TVR), respectively.
Results:
Two-year MACE incidence rates were 9.7%, 15.2%, 30%, and 31% in control, mild CKD, moderate CKD, and dialysis groups, respectively. TVR trended upward with increasing renal impairment (8.3%, 12.5%, 18%, and 21.4% for the 4 groups, respectively, p = 0.09). Mild CKD, moderate CKD, and dialysis patients had adjusted hazard ratios of 2.51 (95% CI, 1.01-6.24); 3.20 (95% CI, 1.07-9.60); and 4.19 (95% CI, 1.30-13.51), respectively, for 2-year MACE.
Conclusions:
A graded relationship was observed between lower renal function and increased TVR, although it did not reach statistical significance. Cardiac death and TVR rates were significantly higher in moderate CKD and dialysis patients after paclitaxel-eluting stent implantation. Patients with reduced renal function, even mild CKD, were independent predictors of MACE.
