The adverse long-term impact of renal impairment in patients undergoing percutaneous coronary intervention in the drug-eluting stent era
Appleby CE et al. – In a large registry of "all comers" for percutaneous coronary intervention, chronic kidney disease (CKD) was an independent predictor of adverse late outcomes. Drug-eluting stent (DES) use may be associated with improved long-term outcomes in this high-risk cohort, pending further prospective studies. Methods- Observational study of long-term impact of CKD on pts undergoing percutaneous coronary intervention at a tertiary cardiac referral center
- Review of baseline creatinine for 11,953 pts in a prospective registry (April 2000-September 2007)
- Pt stratification: pts with or without at least moderate CKD (creatinine clearance, <60 mL/min)
- Follow-up data obtained via linkage to a provincial registry
Results- Cox multiple-regression analysis identified independent predictors of late mortality and major adverse cardiac events (MACE) and examined association between DES use and late outcomes in presence/absence of CKD
- CKD present in 3070 pts (25.7%)
- In-hospital mortality and MACE significantly increased in CKD
- Survival and MACE-free survival reduced at 7 yrs
- CKD was an independent predictor of late mortality and MACE
- DES use was associated with a significant reduction in both
- In pts with CKD, DES use associated with reduced revascularization and reduced MACE but not reduced mortality
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