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Clinical outcomes after percutaneous coronary intervention in non-dialysis patients with acute coronary syndrome and
Yusuke Uemura1, Shinji Ishikawa2, Kenji Takemoto2
1Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 446-8602, Japan. yusuke0307@kosei.anjo.aichi.jp.
Insights
Clinical outcomes for acute coronary syndrome (ACS) patients with advanced kidney dysfunction undergoing percutaneous coronary intervention (PCI) remain poor. ST-elevation myocardial infarction (STEMI) and higher Killip classification predict in-hospital events, while BMI and albumin predict later outcomes.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Limited data exists on clinical outcomes for patients with acute coronary syndrome (ACS) and advanced renal dysfunction (eGFR < 30 mL/min/1.73 m²).
- Percutaneous coronary intervention (PCI) is a common treatment for ACS, but outcomes in this high-risk population are not well-defined.
Purpose of the Study:
- To evaluate the clinical outcomes of ACS patients with non-dialysis advanced renal dysfunction following PCI.
- To identify predictors of in-hospital and post-discharge major adverse cardiac and cerebrovascular events (MACCE).
Main Methods:
- A retrospective study of 194 ACS patients with non-dialysis advanced renal dysfunction who underwent PCI.
- Primary endpoint: incidence of MACCE (all-cause death, myocardial infarction, ischemic stroke).
- Analysis included Kaplan-Meier and multivariate regression to identify predictors.
Main Results:
- The overall MACCE incidence at median follow-up (657.5 days) was 32.3%.
- Patients with ST-elevation myocardial infarction (STEMI) had a significantly higher MACCE incidence (45.4%) compared to non-ST-elevation ACS (NSTE-ACS) (23.4%).
- STEMI and Killip classification ≥ 2 predicted in-hospital MACCE, while body mass index and serum albumin predicted post-discharge MACCE.
Conclusions:
- Short- and long-term prognoses after PCI in ACS patients with advanced renal dysfunction are unfavorable.
- Identifying high-risk patients (STEMI, Killip ≥ 2) and monitoring nutritional status (BMI, albumin) is crucial for improving outcomes.
Background:
Data about the clinical outcomes of ACS patients with advanced renal dysfunction (estimated glomerular filtration rate < 30 mL/min/1.73 m2) following percutaneous coronary intervention (PCI) are limited.
Methods:
We examined the data obtained from 194 ACS patients with non-dialysis advanced renal dysfunction who underwent PCI at five hospitals. The primary composite endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, and ischemic stroke).
Results:
Eighty patients (41.2%) were diagnosed with ST-elevation myocardial infarction (STEMI), and 117 patients (58.8%) with non-ST-elevation ACS (NSTE-ACS). Overall patients were followed for a median of 657.5 days. Cumulative incidence of MACCE at median follow-up was 32.3% (45.4% for STEMI and 23.4% for NSTE-ACS). Kaplan-Meier analysis demonstrated that patients in the STEMI group had significantly higher incidence of MACCE than those in the non-STEMI and unstable angina group (Log-rank p < 0.001). In-hospital MACCE rate was higher in the STEMI group than in the NSTE-ACS group, whereas post-discharge MACCE rate was comparable between the two groups. In the multivariate analysis, STEMI and Killip classification ≥ 2 were associated with in-hospital MACCE. On the other hand, body mass index and serum albumin at admission were independent predictors of post-discharge MACCE.
Conclusions:
Short- and long-term prognoses following PCI in non-dialysis patients with ACS and advanced renal dysfunction is still unfavorable. STEMI and Killip classification ≥ 2 were independent predictors for in-hospital MACCE, and body mass index and serum albumin were for post-discharge MACCE.
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