Five-year mortality outcomes in patients with chronic kidney disease undergoing percutaneous coronary intervention
Agam D Patel1, Mohammed Ibrahim1, Rajesh V Swaminathan1
1Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York.
Insights
Patients with chronic kidney disease (CKD) undergoing percutaneous coronary interventions (PCI) face increased risks. Lower estimated glomerular filtration rate (eGFR) is significantly associated with decreased long-term survival after PCI.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Patients with advanced chronic kidney disease (CKD) are at high risk during percutaneous coronary interventions (PCI).
- Limited data exist on quantifying risks and long-term outcomes for CKD patients undergoing PCI.
Purpose of the Study:
- To evaluate peri-procedural and long-term outcomes in patients with CKD undergoing PCI.
- To assess the association between CKD stage and mortality after PCI.
Main Methods:
- Prospective data collection from 6,478 patients undergoing PCI (2009-2013) from the Cornell Coronary Registry.
- Patients were stratified into CKD stages based on estimated glomerular filtration rate (eGFR).
- Analysis included procedural outcomes, 30-day events, and 5-year all-cause mortality.
Main Results:
- Higher incidence of acute heart failure, stroke, new dialysis, transfusions, and bleeding events observed with increasing CKD stage.
- Five-year survival rates decreased significantly with CKD progression: 98.1% (stage 1) to 76.9% (stage 5).
- Multivariate analysis showed significantly increased hazard ratios for all-cause mortality in CKD stages 3-5 compared to stage 1.
Conclusions:
- Lower estimated glomerular filtration rate (eGFR) is a significant predictor of decreased long-term survival in patients undergoing PCI.
- CKD stage is independently associated with adverse peri-procedural outcomes and long-term mortality after PCI.
Objective:
To examine peri-procedural and long-term outcomes in patients with chronic kidney disease (CKD) undergoing percutaneous coronary interventions (PCI).
Background:
Patients with advanced CKD are considered high risk when undergoing PCI. Limited published data exist on quantifying risk and assessment of long-term outcomes after PCI in this group.
Methods:
Examining the Cornell Coronary Registry, we prospectively collected data of 6,478 consecutive patients who underwent elective or urgent PCI between 2009 and 2013. Patients were grouped into CKD stages by estimated glomerular filtration rate (eGFR) according to KDOQI guidelines. Procedural and 30-day outcomes are reported with assessment of long-term differences in 5-year all-cause mortality.
Results:
Patients were grouped by CKD stages: 1,351 patients with eGFR ≥90 mL/min/1.73 m2 (stage 1), 2,882 with eGFR 60-89 (stage 2), 1,742 with eGFR 30-59 (stage 3), 191 with eGFR 15-29 (stage 4), and 312 with eGFR <15 or on dialysis (stage 5). The incidence of post-procedural acute heart failure, stroke, new dialysis requirement, transfusions, and bleeding events were higher in patients with greater CKD stage (P < 0.05). Five-year Kaplan-Meier overall survival among CKD stages 1-5 was 98.1, 95.5, 91.8, 82.5, and 76.9%, respectively (P < 0.001 by log-rank test). The hazard ratios of all-cause mortality for CKD stages 2-5 as compared to stage 1 by multivariate Cox regression analysis were as follows: 1.32 (P = 0.26), 2.04 (P < 0.01), 2.79 (P < 0.01), and 5.49 (P < 0.001).
Conclusion:
Among patients undergoing PCI, lower GFR is associated with decreased long-term survival. © 2016 Wiley Periodicals, Inc.
