Background
Renal disease confers a strong independent risk for morbidity and mortality after
percutaneous coronary intervention (PCI). We evaluated the relationship between baseline
pre-procedural renal function and outcomes following PCI.
Methods
We examined 45,287 patients who underwent PCI in British Columbia. We evaluated all-cause
mortality and target vessel revascularisation (TVR) at 2 years. Pre-procedural renal
impairment was categorised by creatinine clearance (CrCl, mL/min): CrCl≥90 (n=14,876),
90>CrCl≥60 (n=10,219), 60>CrCl≥30 (n=14,876), 30>CrCl≥0 (n=2,594) and dialysis (n=579).
Results
Declining CrCl values less than 60 mL/min were progressively associated with greater
mortality: 60>eGFR≥30 (HR=2.01, 95% CI 1.71–2.37, p<0.001); 30>eGFR≥0 (HR=4.10, 95%
CI 3.39–4.95, p<0.001); and dialysis (HR=6.22, 95% CI 5.07–7.63, p<0.001). A reduction
in eGFR was not associated with TVR in non-dialysis patients. However, dialysis was
a strong independent predictor for TVR (HR=1.69, 95% CI 1.37–2.08, p<0.001). This
was confirmed in propensity-matched analyses where, dialysis was strongly associated
with TVR (HR=1.53, 95% CI 1.24–1.89, p<0.001). This association was consistently seen
in stratified analyses for diabetic versus non-diabetic patients; stent length >30
mm versus <30 mm; stent diameter >3 mm versus <3 mm; and receipt of bare metal stents
versus drug-eluting stents.
Conclusions
This study indicates the association with declining renal function and mortality in
patients undergoing PCI. Whilst renal disease was not associated with increased TVR
in non-dialysis patients, dialysis-dependence was a strong independent predictor for
increased TVR.
Keywords
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Article info
Publication history
Published online: March 14, 2022
Accepted:
November 2,
2021
Received in revised form:
June 25,
2021
Received:
January 22,
2020
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
