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Updated: May 26, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Clinical outcomes after complex and high-risk percutaneous coronary intervention according to baseline chronic kidney
Francesca Maria Di Muro1,2, Samantha Sartori1, Birgit Vogel1
1Icahn School of Medicine at Mount Sinai, Mount Sinai Fuster Heart Hospital, New York, NY, USA.
Insights
Chronic kidney disease (CKD) significantly increases risks for major adverse cardiovascular events (MACE) and bleeding after complex high-risk percutaneous coronary intervention (CHIP). CKD also doubles the risk of contrast-associated acute kidney injury (CA-AKI) post-procedure.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Chronic kidney disease (CKD) is linked to poor outcomes in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI).
- The prognostic impact of CKD in complex high-risk PCI (CHIP) patients was previously unknown.
Purpose of the Study:
- To investigate the association between CKD and outcomes in patients undergoing CHIP.
- To evaluate the risk of major adverse cardiovascular events (MACE), bleeding, and contrast-associated acute kidney injury (CA-AKI) in CHIP patients with CKD.
Main Methods:
- A cohort of 4855 CHIP patients treated between 2012 and 2022 was analyzed.
- Patients were stratified based on CKD status (eGFR < 60 ml/min/1.73m²).
- Multivariable Cox regression adjusted for risk factors and comorbidities was used to assess outcomes, including MACE (mortality, MI, stroke) and bleeding at one year.
Main Results:
- 39.6% of CHIP patients had CKD, presenting with older age, more comorbidities, and complex CAD.
- CKD was associated with significantly increased 1-year risks of MACE (driven by mortality and MI) and bleeding.
- While in-hospital ischemic and bleeding event rates were similar, CKD patients experienced twice the rate of CA-AKI.
Conclusions:
- CKD is a potent predictor of adverse ischemic and bleeding events at one year in CHIP patients.
- CKD doubles the risk of post-procedural CA-AKI, highlighting the need for specialized management.
- Tailored risk assessment and management strategies are crucial for this high-risk CHIP population with CKD.
Background:
Chronic kidney disease (CKD) is associated with unfavorable outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). However, its prognostic role in patients undergoing complex high-risk PCI (CHIP) remains unexplored, prompting our investigation.
Methods:
Consecutive CHIP patients treated at a tertiary care center from 2012 to 2022 were included in the current analysis. CHIP was identified by the presence of at least one patient and one procedural criterion from a validated score. Patients were stratified by CKD status, with CKD defined as eGFR < 60 ml/min/1.73m2. The primary endpoint was one-year incidence of major adverse cardiovascular events (MACE), including all-cause mortality, spontaneous myocardial infarction (MI), and stroke. A multivariable Cox regression model was computed adjusted for relevant baseline risk factors and comorbidities.
Results:
Among 4855 CHIP patients, 39.6% (n = 1925) had CKD at baseline. CKD patients were older, with more comorbidities, and complex CAD. After multivariable adjustment, CKD was associated with increased 1-year risks of MACE (primarily driven by all-cause mortality and MI rates), and bleeding. In-hospital adjusted hazards for ischemic and bleeding events were similar between the two cohorts, while CA-AKI occurred twice as often in CKD patients compared to non-CKD ones.
Conclusions:
In CHIP patients, CKD is a strong predictor of ischemic and bleeding events at one-year follow-up and doubles the risk of post-procedural CA-AKI, underscoring the need for tailored risk assessment and management of this vulnerable population.
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