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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Impaired Kidney Function and 10-Year Outcome After Percutaneous Coronary Intervention-Interaction with Age, Sex,
Gjin Ndrepepa1, Sebastian Kufner1,2, Salvatore Cassese1
1Department of Cardiology, Deutsches Herzzentrum München, TUM Universitätsklinikum, Lazarettstrasse 36, 80636 München, Germany.
Insights
Chronic kidney disease (CKD) significantly increases 10-year mortality risk in patients undergoing percutaneous coronary intervention (PCI). This risk is amplified in younger individuals and those with acute coronary syndromes.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Limited data exists on the long-term impact of chronic kidney disease (CKD) on outcomes after percutaneous coronary intervention (PCI).
- Understanding this association is crucial for risk stratification and patient management following PCI in coronary artery disease (CAD).
Purpose of the Study:
- To evaluate the association between chronic kidney disease (CKD) and 10-year mortality in patients who have undergone percutaneous coronary intervention (PCI).
- To investigate potential interactions of CKD with age and clinical presentation on long-term mortality after PCI.
Main Methods:
- A cohort of 5571 patients with coronary artery disease (CAD) undergoing PCI was analyzed.
- Patients were stratified into four groups based on estimated glomerular filtration rate (eGFR): ≥90, 60-89, 30-59, and <30 mL/min/1.73 m².
- The primary endpoint was all-cause mortality assessed over a 10-year follow-up period.
Main Results:
- Higher mortality rates were observed with decreasing eGFR levels, with the lowest eGFR group (<30 mL/min/1.73 m²) showing the highest mortality.
- CKD was independently associated with a 2.16-fold increased risk of 10-year mortality (adjusted hazard ratio).
- Significant interactions indicated that CKD conferred a stronger mortality risk in younger patients and those presenting with acute coronary syndromes. Inclusion of eGFR improved the predictive model's C-statistic.
Conclusions:
- Chronic kidney disease (CKD) is significantly associated with increased 10-year all-cause mortality in patients with coronary artery disease (CAD) undergoing PCI.
- The detrimental impact of CKD on mortality is particularly pronounced in younger patients and those experiencing acute coronary syndromes.
- Estimating glomerular filtration rate (eGFR) is a valuable tool for refining prognostic assessments in patients undergoing PCI.
Abstract:
Background: Limited evidence exists regarding the association of chronic kidney disease (CKD) with long-term outcomes following percutaneous coronary intervention (PCI). We aimed to assess the association of CKD with 10-year outcome after PCI. Methods: This study included 5571 patients with coronary artery disease (CAD) undergoing PCI. Patients were categorized in groups according to the estimated glomerular filtration rate (eGFR) values: eGFR ≥ 90 mL/min/1.73 m2, (normal kidney function), 60 to <90 mL/min/1.73 m2 (mild kidney impairment), 30 to <60 mL/min/1.73 m2 (mild-to-moderate and moderate-to-severe kidney impairment) and <30 mL/min/1.73 m2 (severe kidney impairment). The primary endpoint was all-cause mortality at 10 years. Results: All-cause deaths occurred in 155 patients (86.3%) with eGFR < 30 mL/min/1.73 m2, 602 patients (59.1%) with eGFR 30 to <60 mL/min/1.73 m2, 775 patients (31.3%) with eGFR 60 to <90 mL/min/1.73 m2 and 220 patients (15.8%) with eGFR ≥ 90 mL/min/1.73 m2 (adjusted hazard ratio = 2.16, 95% confidence interval 1.84 to 2.54, p < 0.001, for 30 mL/min/1.73 m2 decrement in the eGFR). There were CKD-by-age (Pint < 0.001) and CKD-by-clinical presentation (Pint = 0.017) interactions showing a stronger association of CKD with mortality in younger patients and those presenting with acute coronary syndromes. The C statistic of the multivariable model for mortality increased from 0.748 [0.737-0.759] to 0.766 [0.755-0.777] (p < 0.001) after the inclusion of eGFR in the model. Conclusions: In patients with CAD undergoing PCI, CKD was associated with higher mortality at 10 years compared with patients with preserved renal function. The association between CKD and mortality was stronger in patients of younger age and those presenting with acute coronary syndromes.
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