Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Impact of Chronic Kidney Disease on Long-Term Outcome in Coronary Bypass Candidates Treated with Percutaneous Coronary Intervention

  • Peng, Jian-Rong (Division of Cardiovascular, Department of Internal Medicine, Chang Gung University) ;
  • Chang, Chi-Jen (Division of Cardiovascular, Department of Internal Medicine, Chang Gung University) ;
  • Wang, Chun-Li (Division of Cardiovascular, Department of Internal Medicine, Chang Gung University) ;
  • Tung, Ying-Chang (Division of Cardiovascular, Department of Internal Medicine, Chang Gung University) ;
  • Lee, Hsin-Fu (Division of Cardiovascular, Department of Internal Medicine, Chang Gung University)
  • Received : 2016.03.06
  • Accepted : 2016.09.09
  • Published : 2017.01.31
⟨ Previous Next ⟩

Abstract

Background and Objectives: The aim of this study was to identify clinical, lesional, and procedural predictors for adverse outcomes of coronary angioplasty and stenting in coronary bypass candidates. Subjects and Methods: This cohort study included 107 consecutive candidates for coronary artery bypass surgery who underwent percutaneous coronary intervention with multiple coronary stents between Jan 2004 and Dec 2011. The study endpoint was major adverse cardiovascular events (MACEs) including all-cause mortality, nonfatal myocardial infarction, repeat revascularization, and stent thrombosis. Follow up was from the date of index percutaneous coronary intervention to the date of the first MACE, date of death, or December 31, 2015, whichever came first. Results: In this study (age $62.3{\pm}11.2years$, 86% male), 38 patients (36%) had MACE. Among baseline, angiographic, and procedural parameters, there were significant differences in lower left ventricular ejection fraction (LVEF) and worse renal function. In a Cox regression model, LVEF and chronic kidney disease (CKD) were significant predictors for MACE. After a multivariate adjustment, CKD remained a significant predictor of MACEs (hazard ratio: 2.97, 95% confidence interval: 1.50-5.90). Conclusions: For coronary bypass candidates who were treated with coronary angioplasty and stenting, CKD seems to be the strongest predictor for adverse outcomes compared with other traditional factors.

Keywords

References

  1. Onuma Y, Wykrzykowska JJ, Garg S, et al. 5-Year follow-up of coronary revascularization in diabetic patients with multivessel coronary artery di sease: i nsights from ARTS (arterial revascularization therapy study)-II and ARTS-I trials. JACC Cardiovasc Interv 2011;4:317-23. https://doi.org/10.1016/j.jcin.2010.12.004
  2. Serruys PW, Onuma Y, Garg S, et al. 5-Year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. J Am Coll Cardiol 2010;55:1093-101. https://doi.org/10.1016/j.jacc.2009.11.049
  3. Serruys PW, Ong AT, Morice MC, et al. Arterial revascularisation therapies study part ii-sirolimus-eluting stents for the treatment of patients with multivessel de novo coronary artery lesions. EuroIntervention 2005;1:147-56.
  4. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013;381:629-38. https://doi.org/10.1016/S0140-6736(13)60141-5
  5. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-72. https://doi.org/10.1056/NEJMoa0804626
  6. Park SJ, Ahn JM, Kim YH, et al. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015;372:1204-12. https://doi.org/10.1056/NEJMoa1415447
  7. Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006;145:247-54. https://doi.org/10.7326/0003-4819-145-4-200608150-00004
  8. Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005;1:219-27.
  9. Cannon CP, Battler A, Brindis RG, et al. American college of cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes. a report of the american college of cardiology task force on clinical data standards (Acute coronary syndromes writing committee). J Am Coll Cardiol 2001;38:2114-30. https://doi.org/10.1016/S0735-1097(01)01702-8
  10. Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE. Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med 2007;356:1020-9. https://doi.org/10.1056/NEJMoa067731
  11. Reddan DN, Szczech LA, Tuttle RH, et al. Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol 2003;14:2373-80. https://doi.org/10.1097/01.ASN.0000083900.92829.F5
  12. Hemmelgarn BR, Southern D, Culleton BF, et al. Survival after coronary revascularization among patients with kidney disease. Circulation 2004;110:1890-5. https://doi.org/10.1161/01.CIR.0000143629.55725.D9
  13. Ix JH, Mercado N, Shlipak MG, et al. Association of chronic kidney disease with clinical outcomes after coronary revascularization: the Arterial Revascularization Therapies Study (ARTS). Am Heart J 2005;149:512-9. https://doi.org/10.1016/j.ahj.2004.10.010
  14. Panichi V, Migliori M, De Pietro S, et al. C reactive protein in patients with chronic renal diseases. Ren Fail 2001;23:551-62. https://doi.org/10.1081/JDI-100104737
  15. Sarnak MJ, Coronado BE, Greene T, et al. Cardiovascular disease risk factors in chronic renal insufficiency. Clin Nephrol 2002;57:327-35. https://doi.org/10.5414/CNP57327
  16. Navab KD, Elboudwarej O, Gharif M, et al. Chronic inflammatory disorders and accelerated atherosclerosis: chronic kidney disease. Curr Pharm Des 2011;17:17-20. https://doi.org/10.2174/138161211795049787
  17. Polonsky TS, Bakris GL. Chronic kidney disease: a coronary heart disease equivalent? Lancet 2012;380:783-5. https://doi.org/10.1016/S0140-6736(12)60772-7
  18. Holper EM, Blair J, Selzer F, et al. The impact of ejection fraction on outcomes after percutaneous coronary intervention in patients with congestive heart failure: an analysis of the national heart, lung, and blood institute percutaneous transluminal coronary angioplasty registry and dynamic registry. Am Heart J 2006;151:69-75. https://doi.org/10.1016/j.ahj.2005.03.053
  19. Tomai F, Ribichini F, De Luca L, et al. Randomized comparison of xience v and multi-link vision coronary stents in the same multivessel patient with chronic kidney disease (Renal-Des) study. Circulation 2014;129:1104-12. https://doi.org/10.1161/CIRCULATIONAHA.113.005186

Cited by

  1. Long-term outcomes of patients with stable coronary disease and chronic kidney dysfunction: 10-year follow-up of the Medicine, Angioplasty, or Surgery Study II Trial vol.35, pp.8, 2017, https://doi.org/10.1093/ndt/gfy379
  2. Impact of chronic kidney disease on long-term outcomes for coronary in-stent restenosis after drug-coated balloon angioplasty vol.78, pp.6, 2021, https://doi.org/10.1016/j.jjcc.2021.08.010