Outcomes after percutaneous coronary interventions in patients with CKD: improved outcome in the stenting era.
BACKGROUND
Percutaneous coronary intervention (PCI) with stenting reduces adverse events in the general population compared with balloon angioplasty. The benefit of stents in high-risk patients normally excluded from clinical trials has not been well studied. Outcomes after PCIs in patients with chronic kidney disease (CKD) before and after widespread use of stents were compared.


METHODS
All patients undergoing PCIs at our center within 2 periods selected for high and low stent use were included. Demographic, kidney and cardiac function, and PCI data were collected. Kaplan-Meier curves were constructed, and Cox proportional hazards analysis was used to assess the effect of high stent use on major adverse cardiac event, a composite of cardiac revascularization, myocardial infarction, or death 3 years after PCI.


RESULTS
A total of 1,879 patients (780 patients, low stent use; 1,099 patients, high stent use; 18% and 94.1% stent use, respectively) with a mean age of 63 years, 73% men, and 26% of patients with a glomerular filtration rate less than 60 mL/min were included. At baseline, there was a greater prevalence of severe CKD, cardiac risk factors, and cardiovascular disease in the high-stent-use cohort. Major adverse cardiac events were reduced in the contemporary cohort (hazard ratio, 0.61; 95% confidence interval, 0.52 to 0.72); this benefit extended across all stages of kidney function.


CONCLUSIONS
Patients with CKD undergoing PCI in the stenting era show improved outcomes. Additional studies are needed to determine optimal revascularization strategies in patients with CKD.
Stigant
Caroline
C
Department of Health Care and Epidemiology, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
Izadnegahdar
Mona
M
Levin
Adeera
A
Buller
Christopher E
CE
Humphries
Karin H
KH
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D023921:Coronary Stenosis / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000453:epidemiology; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D016016:Proportional Hazards Models; D012008:Recurrence; D012306:Risk; D015607:Stents / Q000706:statistics & numerical data*; D016896:Treatment Outcome