Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry.
The purpose of this study was to evaluate the clinical impact of chronic kidney disease (CKD) on clinical outcomes in contemporary practice of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES).



Although second-generation DES have improved the safety and efficacy issues in PCI, data regarding the performance of second-generation DES in patients with CKD are still limited.



We performed a patient-level pooled analysis on 12,426 patients undergoing PCI using second-generation DES from the Korean Multicenter Drug-Eluting Stent Registry. Endpoints were stent-oriented outcomes (target lesion failure [TLF]) and patient-oriented composite outcomes (POCO) during a median follow-up of 35 months. CKD patients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal disease patients, and by the coexistence of diabetes mellitus (DM).



A total of 2,927 patients had CKD (23.6%), who showed a significantly higher risk of TLF (adjusted hazard ratio [HRadjust]: 1.50; 95% confidence interval [CI]: 1.21 to 1.86) and POCO (HRadjust1.34; 95% CI: 1.17 to 1.55) compared to patients with preserved renal function. Stratified analysis by eGFR showed that TLF was not increased in the mild to moderate CKD, whereas severe CKD and dialysis-dependent patients showed significantly higher risk of TLF (HRadjust2.44; 95% CI: 1.54 to 3.86; HRadjust3.58; 95% CI: 2.52 to 5.08, respectively). The eGFR threshold of increased clinical events was 40 to 45 ml/min/1.73 m2. Among CKD patients, DM CKD patients showed a higher incidence of TLF compared to non-DM CKD patients (HRadjust: 1.82; 95% CI: 1.32 to 2.52), driven by the increase in target vessel-related events.



In the era of second-generation DES, CKD patients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal disease patients.
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea.
Joo Myung
JM
Lee
Department of Medicine, Seoul National University Hospital, Seoul, Korea; Molecular Medicine & Biopharmaceutical Science, Graduate School of Convergence Science & Technology, Seoul National University, Seoul, Korea.
Jeehoon
J
Kang
Department of Medicine, Seoul National University Hospital, Seoul, Korea.
Euijae
E
Lee
Department of Medicine, Seoul National University Hospital, Seoul, Korea.
Doyeon
D
Hwang
Department of Medicine, Seoul National University Hospital, Seoul, Korea.
Tae-Min
TM
Rhee
Department of Medicine, Seoul National University Hospital, Seoul, Korea.
Jonghanne
J
Park
Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea.
Hack-Lyoung
HL
Kim
Department of Medicine, Seoul National University Hospital, Seoul, Korea.
Sang Eun
SE
Lee
Department of Medicine, Seoul National University Hospital, Seoul, Korea.
Jung-Kyu
JK
Han
Department of Medicine, Seoul National University Hospital, Seoul, Korea.
Han-Mo
HM
Yang
Department of Medicine, Seoul National University Hospital, Seoul, Korea.
Kyung Woo
KW
Park
Department of Internal Medicine and Emergency Medical Center, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea.
Sang-Hoon
SH
Na
Department of Medicine, Seoul National University Hospital, Seoul, Korea.
Hyun-Jae
HJ
Kang
Department of Medicine, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea.
Bon-Kwon
BK
Koo
Department of Medicine, Seoul National University Hospital, Seoul, Korea; Molecular Medicine & Biopharmaceutical Science, Graduate School of Convergence Science & Technology, Seoul National University, Seoul, Korea. Electronic address: hyosoo@snu.ac.kr.
Hyo-Soo
HS
Kim
D000368:Aged; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chronic kidney disease; chronic renal failure; clinical outcomes; coronary artery disease; drug-eluting stent(s); percutaneous coronary intervention