Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug-Eluting Stent Era.

Abstract

BACKGROUND:

There are limited data regarding the prognostic impact of angiographic complete revascularization (CR) in patients with chronic kidney disease (CKD). We sought to investigate the differential prognostic impact of angiographic CR over incomplete revascularization (IR), according to the presence of CKD in the drug-eluting stent era.

METHODS AND RESULTS:

Between 2003 and 2011 at Samsung Medical Center, consecutive patients with multivessel disease were stratified by the presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2) and classified according to angiographic CR (residual SYNTAX score=0) or IR. Clinical outcomes were compared between angiographic CR and IR, stratified by the presence of CKD. Primary outcome was patient-oriented composite outcomes (POCO, a composite of all-cause death, myocardial infarction, any revascularization) at 3 years. Inverse probability weighting was performed between the CR and IR groups. A total of 3224 patients were eligible for analysis: 2295 without CKD; 929 with CKD. Among non-CKD patients, angiographic CR showed a significantly lower risk of POCO than IR (17.2% versus 21.7%, adjusted hazard ratio 0.76, 95% confidence interval, 0.62-0.95, P=0.014), mainly driven by a significantly lower risk of any revascularization. Among CKD patients, however, angiographic CR was associated with a significantly higher risk of POCO than IR (37.7% versus 28.4%, adjusted hazard ratio 1.42, 95% confidence interval, 1.08%-1.85%, P=0.011), mainly driven by a significantly higher risk of nonfatal target vessel myocardial infarction.

CONCLUSIONS:

Angiographic CR was associated with reduced risk of POCO than IR in patients without CKD; however, it was associated with a significantly higher risk of POCO and nonfatal myocardial infarction in CKD patients.

• Authors: Jihoon Kim, Joo Myung Lee, Ki Hong Choi, Tae-Min Rhee, Doyeon Hwang, Jonghanne Park, Chul Ahn, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Jin-Ho Choi, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 7 Issue 4 (02 15 2018) ISSN: 2047-9980 [Electronic] England
• PMID: 29449272 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Topics

• Aged
• Coronary Angiography
• Coronary Artery Disease (diagnostic imaging, mortality, therapy)
• Drug-Eluting Stents
• Female
• Glomerular Filtration Rate
• Humans
• Kidney (physiopathology)
• Male
• Middle Aged
• Percutaneous Coronary Intervention (adverse effects, instrumentation, mortality)
• Predictive Value of Tests
• Prosthesis Design
• Renal Insufficiency, Chronic (diagnosis, mortality, physiopathology)
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome