Deteriorating renal function strong predictor of mortality after PCI
Among adults undergoing PCI, even mild to moderate chronic kidney disease is associated with decreased survival at 1 year in a dose-dependent manner, researchers reported.
In an electronic medical records database analysis of patients in Thailand undergoing PCI, researchers found that patients with stage II CKD were 1.5 times more likely to die of any cause by 1 year after the procedure compared with patients with stage I CKD.
“With the advance in new generations of drug‐eluting stents and adjunctive equipment for PCI, the immediate outcomes of PCI have been significantly improved,” Thosaphol Limpijankit, MD, of the division of cardiology at Ramathibodi Hospital and Mahidol University in Bangkok, Thailand, and colleagues wrote in the study background. “Nevertheless, previous studies have shown that a lower estimated glomerular filtration rate (eGFR) was associated with decreased long‐term survival. In Thailand, with an increasing burden of chronic kidney disease, rising PCI costs and limited healthcare resources, it is necessary to select suitable patients having a better life expectancy.”
Limpijankit and colleagues analyzed data from 22,045 adults who underwent primary or elective PCI from May 2018 to August 2019, using the nationwide prospective Thai PCI registry, initiated by the Cardiac Intervention Association of Thailand.
Patients were classified into six CKD stages according to preprocedure eGFR. Researchers estimated HRs for all‐cause mortality for CKD stages II to V as compared with stage I. Primary outcome was 1‐year all‐cause death; secondary outcomes were 1‐year fatal and nonfatal MI, fatal and nonfatal stroke, and unplanned revascularization.
The findings were published in Clinical Cardiology.
Within the cohort, 26.9% of patients were in CKD stage I, 40.8% were in stage II, 23.2% were in stage III and 3.9% were in stage IV, whereas 1.5% were in stage V without dialysis and 3.7% were in stage V with dialysis.
Overall, in‐hospital all‐cause death occurred frequently in patients with CKD stages IV and V without dialysis, with rates of 11.8%, and 10.1%, respectively. In CKD stages III and V with dialysis, all-cause death rates were comparable at 4.7% and 5.3%, respectively.
The incidence of postprocedural MI, stroke, cardiogenic shock, HF, new dialysis requirement and bleeding events requiring blood transfusion were higher in patients with greater CKD stage. The length of hospital stay was longer in the advanced CKD stages.
During a mean follow-up of 12 months, rates of all‐cause mortality rates were highest in patients with CKD stages IV and V with or without dialysis (34.8%, 32% and 30.6%, respectively), followed by stage III, II, and I (15.6%, 6.9% and 3.7%, respectively), with CV death or sudden cardiac death as the main cause (56.5%).
After adjusting for covariables, CKD stages remained a “strong predictor” of 1‐year all‐cause mortality, according to researchers. Compared with CKD stage I, HRs for all‐cause mortality for CKD stages II through V were 1.5 (95% CI, 1.2-1.7), 2.6 (95% CI, 2.2-3), 5.3 (95% CI, 4.4-6.4), 5.9 (95% CI, 4.6-7.5), and 7 (95% CI, 5.8-8.5), respectively (P for all < .001).
The researchers noted that the analyses were based on a single eGFR measurement taken before the PCI procedure to use for stratification of patients; subsequent effects on renal function were not known. Additionally, CKD might be a surrogate marker for other comorbidities that are also causes of mortality.
“To prove this, a mediation analysis should be further applied,” the researchers wrote.
The researchers wrote that the findings may guide risk classification decision‐making for adults with CKD.
“Whether this risk prediction of the CKD stage can help to reduce the long‐term all‐cause mortality is a question requiring further study,” the researchers wrote.
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