Risk of bleeding and restenosis among chronic kidney disease patients undergoing percutaneous coronary intervention.
BACKGROUND
Bleeding risk is increased in renal failure due to impaired platelet adhesiveness. Patients who undergo percutaneous coronary intervention (PCI) are given multiple antiplatelet agents that increase that risk. We retrospectively tested the hypothesis that chronic kidney disease (CKD) patients who undergo PCI are at higher risk of bleeding and restenosis (due to chronic inflammation) compared to patients with normal renal function.


METHODS
Patients who had PCI for non-ST elevation myocardial infarction or unstable angina between July 2001 and June 2003 (1,184 patients) were included in the study. All the patients were given periprocedural clopidogrel, aspirin and glycoprotein IIb/IIIa inhibitor if indicated, and then continued on clopidogrel and aspirin daily for 12 months. The patients were classified into 5 groups according to the CKD stage and followed-up for 12 months for development of major or minor bleeding, restenosis, length of hospital stay and survival.


RESULTS
The incidence of major bleeding within the first month (3.4% in normal kidney function patients (Gp 1), 4.8% for CKD Stages 1 and 2 patients (Gp2), 5.2% for CKD Stage 3 patients (Gp3), 6.1% for CKD Stage 4 patients (Gp4) and 9.3% for CKD Stage 5 patients (Gp5), p = 0.001) and for minor bleeding (5.7% in Gp1, 6.5% for Gp2, 7.4% for Gp3, 9.2% for Gp4 and 11.3% for Gp5, p = 0.001) and the incidence of restenosis at one month (4.6% in Gp1, 5.3% for Gp2, 6.8% for Gp3, 7.3% for Gp4 and 9.6% for Gp5, p = 0.001) and 6 months (11.2% in Gp1, 13.5% for Gp2, 15.7% for Gp3, 16.4% for Gp4 and 19.7% for Gp5, p = 0.001) were higher with worsening CKD. Survival at one year was worse with worsening of the kidney function.


CONCLUSIONS
Worsening of CKD is associated with progressively increased risk of minor and major bleeding, restenosis and death during and after PCI.
Attallah
N
N
Division of Nephrology and Hypertension, Department of Medicine, CFP-5, Henry Ford Hospital, Detroit, MI 48202, USA. Nattall1@Hfhs.Org
Yassine
L
L
Fisher
K
K
Yee
J
J
D000704:Analysis of Variance; D000789:Angina, Unstable / Q000150:complications / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D023903:Coronary Restenosis / Q000209:etiology*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors