Joo Myung Lee1, Jeehoon Kang2, Euijae Lee3, Doyeon Hwang3, Tae-Min Rhee3, Jonghanne Park3, Hack-Lyoung Kim4, Sang Eun Lee3, Jung-Kyu Han3, Han-Mo Yang3, Kyung Woo Park3, Sang-Hoon Na5, Hyun-Jae Kang3, Bon-Kwon Koo6, Hyo-Soo Kim7. 1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea. 2. Department of Medicine, Seoul National University Hospital, Seoul, Korea; Molecular Medicine & Biopharmaceutical Science, Graduate School of Convergence Science & Technology, Seoul National University, Seoul, Korea. 3. Department of Medicine, Seoul National University Hospital, Seoul, Korea. 4. Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea. 5. Department of Internal Medicine and Emergency Medical Center, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea. 6. Department of Medicine, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea. 7. 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.
Abstract
OBJECTIVES: 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). BACKGROUND: 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. METHODS: 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). RESULTS: 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 (HRadjust 1.34; 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 (HRadjust 2.44; 95% CI: 1.54 to 3.86; HRadjust 3.58; 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. CONCLUSIONS: 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.
OBJECTIVES: 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). BACKGROUND: 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. METHODS: 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. CKDpatients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal diseasepatients, and by the coexistence of diabetes mellitus (DM). RESULTS: 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 (HRadjust 1.34; 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 (HRadjust 2.44; 95% CI: 1.54 to 3.86; HRadjust 3.58; 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 CKDpatients, DMCKDpatients showed a higher incidence of TLF compared to non-DMCKDpatients (HRadjust: 1.82; 95% CI: 1.32 to 2.52), driven by the increase in target vessel-related events. CONCLUSIONS: In the era of second-generation DES, CKDpatients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal diseasepatients.
Authors: Wayne Batchelor; David E Kandzari; Scott Davis; Luis Tami; John C Wang; Islam Othman; Osvaldo S Gigliotti; Amir Haghighat; Sarabjeet Singh; Mario Lopez; Gregory Giugliano; Phillip A Horwitz; Jaya Chandrasekhar; Paul Underwood; Craig A Thompson; Roxana Mehran Journal: JAMA Cardiol Date: 2017-12-01 Impact factor: 14.676
Authors: Felix Mahfoud; Ahmed Farah; Marc-Alexander Ohlow; Norman Mangner; Jochen Wöhrle; Sven Möbius-Winkler; Daniel Weilenmann; Gregor Leibundgut; Florim Cuculi; Nicole Gilgen; Christoph Kaiser; Marco Cattaneo; Bruno Scheller; Raban V Jeger Journal: Clin Res Cardiol Date: 2022-02-27 Impact factor: 6.138
Authors: Chor Cheung Tam; Kelvin Chan; Simon Lam; Arthur Yung; Yui Ming Lam; Carmen Chan; David Siu; Hung Fat Tse Journal: J Int Med Res Date: 2017-07-31 Impact factor: 1.671
Authors: Sean S Scholz; Lucas Lauder; Sebastian Ewen; Saarraaken Kulenthiran; Nikolaus Marx; Orazbek Sakhov; Floris Kauer; Adam Witkowski; Marco Vaglimigli; William Wijns; Bruno Scheller; Michael Böhm; Felix Mahfoud Journal: Clin Res Cardiol Date: 2019-12-02 Impact factor: 5.460