Prognosis after PCI affected by interaction of chronic kidney disease, diabetes in women
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Key takeaways:
- The 3-year prognosis after drug-eluting stent implantation is affected by presence of CKD and/or diabetes.
- The combination was tied to increased risk for all-cause death, MI and stent thrombosis after PCI.
Concomitant chronic kidney disease and diabetes was prognostic of all-cause death and MI within 3 years among women undergoing drug-eluting stent implantation, according to new data.
The Women in Innovation and Drug-Eluting Stents (WIN-DES) database includes pooled patient-level data of women who underwent PCI from 26 randomized trials and is used to both assess sex-specific DES findings and address underrepresentation of women in clinical trials, according to the study published in EuroIntervention.
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“Chronic kidney disease (CKD) and diabetes mellitus are two common comorbid conditions in patients undergoing PCI and are associated with increased morbidity and mortality, especially when both are present,” Alessandro Spirito, MD, cardiologist and research fellow at the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, and colleagues wrote. “Women undergoing PCI sustain poorer clinical outcomes than men, due to their older age and a higher burden of comorbidities, including CKD and diabetes. Prior studies assessing how the presence of diabetes and CKD affect cardiovascular outcomes in women undergoing PCI have considered the prognostic impact of these conditions separately and not in combination.”
Spirito and colleagues utilized the WIN-DES database to evaluate the impact of CKD — defined as creatine clearance less than 60 mL per minute — and/or diabetes on prognosis among 4,269 women after implantation of a DES (mean age, 68 years).
Effect of CKD/diabetes on PCI outcomes
In the cohort, 42.7% of women had neither CKD nor diabetes; 22.9% had CKD alone; 23% had diabetes alone; and 11.4% had both CKD and diabetes.
The primary outcome was a composite of all-cause death or MI at 3-year follow-up.
Compared with women with neither CKD nor diabetes, risk for all-cause death or MI after PCI was not significantly greater among those with CKD alone (adjusted HR = 1.19; 95% CI, 0.88-1.61) or with diabetes alone (aHR = 1.27; 95% CI, 0.94-1.7); however, risk was more than twofold among women with both CKD and diabetes (aHR = 2.64; 95% CI, 1.95-3.56; P for interaction < .001).
Concomitant CKD and diabetes was associated with increased risk for all secondary outcomes, including individual components of the primary outcome as well as cardiac death, definite or probable stent thrombosis and target lesion revascularization. CKD alone and diabetes alone were each associated with increased risk for all-cause death and cardiac death after PCI, but no other secondary outcomes.
Characteristics of women with CKD plus diabetes
Women with CKD were on average 10 years older compared with women without CKD and had lower BMI and higher creatinine values regardless of diabetes status, according to the study.
Additionally, women with CKD and/or diabetes were more likely to have hypertension, hypercholesterolemia, established CAD, multivessel disease, type B2 or C lesions or lesions with moderate or severe calcification and greater total stent length implanted compared with women wither neither CKD nor diabetes (P for all < .01).
“In aggregate, our observations suggest that even though diabetes and CKD are interrelated and share common pathophysiological mechanisms that lead to accelerated atherosclerosis and enhanced blood thrombogenicity, diabetes alone might induce a faster progression of CAD and be a stronger risk factor for stent-related complications than CKD alone,” the researchers wrote. “Optimal medical therapy together with percutaneous or — especially in diabetic patients with extended CAD — surgical coronary revascularization have been demonstrated to decrease morbidity and mortality related to CAD, irrespective of concomitant diabetes or CKD.
“Our study provides valuable insights on how the prognosis of women undergoing PCI is affected by the interaction between diabetes and CKD and highlights the utility of stratifying women according to these two comorbidities for decision-making on therapy and further management,” the researchers wrote.
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