DOI QR코드

DOI QR Code

Impact of Chronic Kidney Disease on Clinical Outcomes in Diabetic Patients Undergoing Percutaneous Coronary Intervention in the Era of Newer-Generation Drug-Eluting Stents

  • Kim, Su-Min (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Tripathy, Dipti Ranjan (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Park, Sang Wook (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Park, Bonil (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Son, Jung-Woo (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Lee, Jun-Won (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Youn, Young Jin (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Ahn, Sung-Gyun (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Ahn, Min Soo (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Kim, Jang-Young (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Yoo, Byung-Su (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Lee, Seung-Hwan (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Yoon, Junghan (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine)
  • Received : 2016.08.29
  • Accepted : 2016.11.22
  • Published : 2017.03.31

Abstract

Background and Objectives: Chronic kidney disease (CKD) is known to be a major adverse predictor in diabetes mellitus (DM) patients undergoing percutaneous coronary intervention (PCI). It is expected that the use of newer-generation drug-eluting stents (DES) would improve clinical outcomes in these patients. We evaluated the impact of CKD on clinical outcomes in diabetic patients undergoing PCI using newer-generation DES in a real-world setting. Subjects and Methods: A total of 887 patients who underwent PCI with newer-generation DES and who had a history of DM or HbA1c >6.5% at the time of hospitalization were analyzed. These patients were divided into groups without CKD (n=549) and with CKD (n=338). Among survivors at discharge, a patient-oriented composite outcome (POCO) including all-cause mortality, myocardial infarction (MI), and revascularization was evaluated, together with a device-oriented composite outcome (DOCO) including cardiac death, target vessel-related MI, and target lesion revascularization at a follow-up period of one year. Results: The incidence of POCO (5.4% vs. 14.0%, log-rank p<0.001) and DOCO (1.1% vs. 4.1%, log-rank p<0.001) was higher in patients with CKD. According to multivariate analysis, which was adjusted for baseline differences in demographic, clinical, and angiographic factors, the presence of CKD was an independent predictor of POCO (hazard ratio [HR]: 1.82, 95% confidence interval [CI]: 1.07 to 3.12), but not of DOCO (HR 2.08, 95% CI: 0.69-6.28). Conclusion: In DM patients, CKD is an independent and powerful predictor of patient-related outcomes, but not of device-related outcomes in the era of newer-generation DES.

Keywords

References

  1. Fox CS, Larson MG, Leip EP, Meigs JB, Wilson PW, Levy D. Glycemic status and development of kidney disease: the framingham heart study. Diabetes Care 2005;28:2436-40. https://doi.org/10.2337/diacare.28.10.2436
  2. Wilson SR, Vakili BA, Sherman W, Sanborn TA, Brown DL. Effect of diabetes on long-term mortality following contemporary percutaneous coronary intervention: analysis of 4,284 cases. Diabetes Care 2004;27:1137-42. https://doi.org/10.2337/diacare.27.5.1137
  3. Gruberg L, Dangas G, Mehran R, et al. Clinical outcome following percutaneous coronary interventions in patients with chronic renal failure. Catheter Cardiovasc Interv 2002;55:66-72. https://doi.org/10.1002/ccd.10103
  4. Best PJ, Lennon R, Ting HH, et al. The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol 2002;39:1113-9. https://doi.org/10.1016/S0735-1097(02)01745-X
  5. Nikolsky E, Mehran R, Turcot D, et al. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol 2004;94:300-5. https://doi.org/10.1016/j.amjcard.2004.04.023
  6. Lepor NE. Impact of chronic kidney disease and diabetes on percutaneous coronary intervention outcomes. Rev Cardiovasc Med 2006;7(Suppl 4):S38-48.
  7. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41. https://doi.org/10.1159/000180580
  8. Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007;115:2344-51. https://doi.org/10.1161/CIRCULATIONAHA.106.685313
  9. Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011;123:2736-47. https://doi.org/10.1161/CIRCULATIONAHA.110.009449
  10. Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet 2013;382:260-72. https://doi.org/10.1016/S0140-6736(13)60687-X
  11. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53. https://doi.org/10.2337/diacare.27.5.1047
  12. Diabetes mellitus: a major risk factor for cardiovascular disease. A joint editorial statement by the American Diabetes Association; The National Heart, Lung, and Blood Institute; The Juvenile Diabetes Foundation International; The National Institute of Diabetes and Digestive and Kidney Diseases; and The American Heart Association. Circulation 1999;100:1132-3. https://doi.org/10.1161/01.CIR.100.10.1132
  13. Mathew V, Gersh BJ, Williams BA, et al. Outcomes in patients with diabetes mellitus undergoing percutaneous coronary intervention in the current era: a report from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial. Circulation 2004;109:476-80. https://doi.org/10.1161/01.CIR.0000109693.64957.20
  14. Appleby CE, Ivanov J, Lavi S, et al. The adverse long-term impact of renal impairment in patients undergoing percutaneous coronary intervention in the drug-eluting stent era. Circ Cardiovasc Interv 2009;2:309-16. https://doi.org/10.1161/CIRCINTERVENTIONS.108.828954
  15. Latif F, Kleiman NS, Cohen DJ, et al. In-hospital and 1-year outcomes among percutaneous coronary intervention patients with chronic kidney disease in the era of drug-eluting stents: a report from the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry. JACC Cardiovasc Interv 2009;2:37-45. https://doi.org/10.1016/j.jcin.2008.06.012
  16. Piccolo R, Pilgrim T, Heg D, et al. Comparative effectiveness and safety of new-generation versus early-generation drug-eluting stents according to complexity of coronary artery disease: a patientlevel pooled analysis of 6,081 patients. JACC Cardiovasc Interv 2015;8:1657-66. https://doi.org/10.1016/j.jcin.2015.08.013
  17. Alexander KP, Chen AY, Roe MT, et al. Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. JAMA 2005;294:3108-16. https://doi.org/10.1001/jama.294.24.3108
  18. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 2002;105:2259-64. https://doi.org/10.1161/01.CIR.0000016043.87291.33

Cited by

  1. Safety and effectiveness of percutaneous coronary intervention using rotational atherectomy and new-generation drug-eluting stents for calcified coronary artery lesions in patients with chronic kidney vol.73, pp.3, 2017, https://doi.org/10.1016/j.ihj.2021.04.007
  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
  3. The roles of sodium and volume overload on hypertension in chronic kidney disease vol.40, pp.4, 2021, https://doi.org/10.23876/j.krcp.21.800