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Impact of renal function in high bleeding risk patients undergoing percutaneous coronary intervention: a
Toshiki Kuno1,2, Bimmer Claessen1, Davide Cao1
1The Zena and Michael A. Wiener Cardiovascular Institute, Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA.
Insights
Chronic kidney disease (CKD) significantly increases ischemic event risk in high bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI). Reduced renal function independently predicts major adverse ischemic events post-PCI, but not major bleeding after adjustment.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) in high bleeding risk (HBR) patients with chronic kidney disease (CKD) requires further outcome evaluation.
- Limited data exists on the interplay between CKD and ischemic/bleeding events following PCI in HBR populations.
Purpose of the Study:
- To assess the association between CKD and both ischemic and bleeding outcomes in HBR patients undergoing PCI.
- To identify the independent predictive value of reduced renal function on adverse events post-PCI in this cohort.
Main Methods:
- Analysis of 10,502 patients from four PCI post-approval registries.
- Identification of 2,300 HBR patients based on ARC-HBR criteria.
- Classification of CKD based on estimated glomerular filtration rate (eGFR): severe (eGFR < 30), moderate (eGFR 30-59), and no CKD (eGFR ≥ 60 mL/min/1.73 m²).
- Evaluation of primary endpoint (cardiac death, myocardial infarction, stent thrombosis) and safety endpoint (major bleeding) up to 4-year follow-up.
Main Results:
- HBR patients with CKD exhibited higher rates of comorbidities and were more frequently female.
- Reduced renal function was linked to significantly higher rates of the primary ischemic endpoint (severe CKD: 30.2%, moderate CKD: 12.5% vs. no CKD: 9.1%, P < 0.01).
- Major bleeding rates were also higher in CKD groups (10.3% severe, 8.9% moderate vs. 6.4% no CKD, P = 0.03).
- After adjustment, both severe and moderate CKD remained independent predictors of the primary ischemic endpoint (HR 2.84 and 1.48, respectively).
- Adjusted analysis showed no significant association between reduced renal function and major bleeding.
Conclusions:
- In HBR patients undergoing PCI, CKD significantly impacts major ischemic events.
- Reduced renal function is an independent predictor of adverse ischemic outcomes post-PCI in HBR patients.
- While bleeding risk is higher in CKD patients, this association is attenuated after statistical adjustment.
Abstract:
Data on ischemic and bleeding outcomes after percutaneous coronary intervention (PCI) in high bleeding risk (HBR) patients with chronic kidney disease (CKD) are scarce. We aimed to evaluate the association between CKD and ischemic and bleeding outcomes in HBR patients who underwent PCI. Among 10,502 patients in the four post-approval registries evaluating patients undergoing PCI, 2,300 patients presented with at least one major or two minor ARC-HBR criteria. CKD was defined as eGFR < 60 mL/min/1.73 m2. These HBR patients were divided into 3 groups: eGFR < 30 mL/min/1.73 m2 defined as severe CKD (N = 221), eGFR 30- < 60 mL/min/1.73 m2 defined as moderate CKD (N = 970), eGFR ≥ 60 mL/min/1.73 m2 defined as no CKD (N = 1,109). The primary endpoint was the composite of cardiac death, myocardial infarction, or stent thrombosis, and the safety endpoint was major bleeding up to 4-year follow-up. HBR patients with CKD were more often female and had higher rates of comorbidities compared to those without CKD. Reduced renal function was associated with higher rates of the primary endpoint (severe CKD vs. moderate CKD vs. no CKD: 30.2% vs. 12.5% vs. 9.1%, P < 0.01) as well as major bleeding (10.3% vs. 8.9% vs. 6.4%, P = 0.03). After adjustment, severe CKD and moderate CKD in HBR patients remained independent predictors for the primary endpoint (HR [95%CI] 2.84 [1.94-4.16], P < 0.01, 1.48 [1.10-2.00], P < 0.01) compared to those with no CKD. However, decreased renal function was no longer significantly associated with major bleeding after adjustment. In conclusions, in HBR patients undergoing PCI, CKD has an important impact on major ischemic events after PCI.
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