Dose-dependent effect of impaired renal function on all-cause mortality in patients following percutaneous coronary
Thosaphol Limpijankit1, Mann Chandavimol1, Suphot Srimahachota2
1Department of Medicine, Division of Cardiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) face increased mortality risk. Lower estimated glomerular filtration rate (eGFR) significantly correlates with reduced survival rates post-PCI.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Chronic kidney disease (CKD) patients have elevated mortality risk post-percutaneous coronary intervention (PCI).
- Limited data exist on the precise mortality risks associated with varying degrees of renal impairment after PCI.
Purpose of the Study:
- To assess the risk prediction of different stages of impaired renal function on all-cause mortality in patients following PCI.
- To quantify the association between pre-procedure estimated glomerular filtration rate (eGFR) and one-year survival after PCI.
Main Methods:
- Subgroup analysis of a nationwide PCI registry involving 22,045 patients.
- Patients categorized into six CKD stages based on pre-procedure eGFR (ml/min/1.73 m²).
- One-year all-cause mortality analyzed using multivariate Cox regression, adjusting for covariables.
Main Results:
- Prevalence of CKD stages I-V (including dialysis) was 26.9%, 40.8%, 23.2%, 3.9%, 1.5%, and 3.7% respectively.
- One-year survival rates decreased significantly with advancing CKD stages (96.3% for stage I to 69.4% for stage V on dialysis).
- Adjusted hazard ratios for mortality increased substantially with lower eGFR, with stage V showing a 7.0-fold increased risk compared to stage I.
Conclusions:
- Reduced pre-procedure eGFR is dose-dependently associated with decreased one-year survival in patients undergoing PCI.
- These findings support improved risk stratification and clinical decision-making for PCI patients with impaired renal function.
Objective:
To determine the risk prediction of various degrees of impaired renal function on all-cause mortality in patients following percutaneous coronary intervention (PCI).
Background:
Patients with chronic kidney disease (CKD) are at high risk of all-cause mortality after PCI. However, there are less data of various degrees of impaired renal function to predict those risks.
Methods:
This was a subgroup analysis of nationwide PCI registry of 22 045 patients. Patients were classified into six CKD stages according to preprocedure estimated glomerular filtration rate (eGFR) (ml/min/1.73 m2 ): I (≥90), II (60-89), III (30-59), IV (15-29), or V (<15) without or with dialysis. Baseline clinical and angiographic characteristics were compared among patients in each stage. One-year all-cause mortality was reported with risk prediction based on CKD stages and other risk factors.
Results:
Patients with CKD stage I-V without and with on dialysis were found in 26.9%, 40.8%, 23.2%, 3.9%, 1.5%, and 3.7%, respectively. PCI procedural success and complication rates ranged from 94.0% to 96.2% and 2.8% to 6.1%, respectively. One-year overall survival among CKD stages I-V was 96.3%, 93.1%, 84.4%, 65.2%, 68.0%, and 69.4%, respectively (p < .001 by log-rank test). After adjusting covariables, the hazard ratios of all-cause mortality for CKD stages II-V as compared to stage I by multivariate Cox regression analysis were 1.5, 2.6, 5.3, 5.9, and 7.0, respectively, (p < .001).
Conclusion:
Among patients undergoing PCI, lower preprocedure eGFR is associated in a dose-dependent effect with decreased 1-year survival. This finding may be useful for risk classification and to guide decision-making.
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