Impact of renal function in high bleeding risk patients undergoing percutaneous coronary intervention: a patient-level stratified analysis from four post-approval studies.

Abstract

Data on ischemic and bleeding outcomes after percutaneous coronary intervention (PCI) in high bleeding risk (HBR) patients with chronic kidney disease (CKD) are scarce. We aimed to evaluate the association between CKD and ischemic and bleeding outcomes in HBR patients who underwent PCI. Among 10,502 patients in the four post-approval registries evaluating patients undergoing PCI, 2,300 patients presented with at least one major or two minor ARC-HBR criteria. CKD was defined as eGFR < 60 mL/min/1.73 m2. These HBR patients were divided into 3 groups: eGFR < 30 mL/min/1.73 m2 defined as severe CKD (N = 221), eGFR 30- < 60 mL/min/1.73 m2 defined as moderate CKD (N = 970), eGFR ≥ 60 mL/min/1.73 m2 defined as no CKD (N = 1,109). The primary endpoint was the composite of cardiac death, myocardial infarction, or stent thrombosis, and the safety endpoint was major bleeding up to 4-year follow-up. HBR patients with CKD were more often female and had higher rates of comorbidities compared to those without CKD. Reduced renal function was associated with higher rates of the primary endpoint (severe CKD vs. moderate CKD vs. no CKD: 30.2% vs. 12.5% vs. 9.1%, P < 0.01) as well as major bleeding (10.3% vs. 8.9% vs. 6.4%, P = 0.03). After adjustment, severe CKD and moderate CKD in HBR patients remained independent predictors for the primary endpoint (HR [95%CI] 2.84 [1.94-4.16], P < 0.01, 1.48 [1.10-2.00], P < 0.01) compared to those with no CKD. However, decreased renal function was no longer significantly associated with major bleeding after adjustment. In conclusions, in HBR patients undergoing PCI, CKD has an important impact on major ischemic events after PCI.

• Authors: Toshiki Kuno, Bimmer Claessen, Davide Cao, Rishi Chandiramani, Paul Guedeney, Sabato Sorrentino, Mitchell Krucoff, Ken Kozuma, Junbo Ge, Ashok Seth, Raj Makkar, Sripal Bangalore, Deepak L Bhatt, Dominick J Angiolillo, Shigeru Saito, Franz-Josef Neumann, James Hermiller, Vinuta Rau, Karine Ruster, Jin Wang, Marco Valgimigli, Roxana Mehran
• Journal: Journal of thrombosis and thrombolysis (J Thromb Thrombolysis) Vol. 52 Issue 2 Pg. 419-428 (Aug 2021) ISSN: 1573-742X [Electronic] Netherlands
• PMID: 33709255 (Publication Type: Journal Article)
• Copyright: © 2021. Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Platelet Aggregation Inhibitors
• ErbB Receptors

Topics

• ErbB Receptors
• Female
• Hemorrhage (etiology)
• Humans
• Kidney (physiology)
• Male
• Percutaneous Coronary Intervention (adverse effects)
• Platelet Aggregation Inhibitors
• Renal Insufficiency, Chronic (complications)
• Risk Factors