Prognostic impact of percutaneous coronary intervention in NSTEMI patients with different stages of chronic kidney disease: a multi-center retrospective study

Background Previous studies have indicated that percutaneous coronary intervention (PCI) may significantly improve clinical outcomes in patients with chronic kidney disease (CKD) and non–ST-segment elevation myocardial infarction (NSTEMI). This study aimed to investigate how different CKD stages influence the prognostic effect of PCI. Objective To evaluate the impact of PCI on key clinical outcomes—including net adverse clinical events (NACE), cardiac death, myocardial infarction, and all-cause mortality—among NSTEMI patients with CKD. Additionally, we aimed to assess whether CKD staging confers a stratified effect on PCI efficacy and to explore any interaction between CKD stage and PCI on these outcomes. Methods This retrospective cohort analysis utilized data from 82 hospitals in the China Cardiovascular Association registry. We enrolled 22,473 adults with NSTEMI and concomitant CKD (KDIGO criteria) between January 2010 and March 2024. Participants were stratified into two cohorts: Early-stage CKD (stages 1-2, eGFR ≥60 mL/min/1.73m²); Advanced CKD (stages 3-5 or dialysis dependence). Propensity score matching (PSM) in a 1:1 ratio was applied to match patients who received PCI with those who did not. After matching, 13,469 patients in the CKD 1–2 group formed 3,179 matched pairs, while 9,004 patients in the CKD 3–5 + dialysis group formed 1,232 matched pairs. In the matched datasets, Cox proportional hazards regression models were used to estimate the independent effect of PCI on the primary endpoint (NACE) and its components (cardiac death, myocardial infarction, all-cause mortality, stroke, and bleeding). Interaction analyses were further performed to assess potential synergistic or antagonistic effects between CKD stage and PCI on NACE. Results In the CKD 3–5 group, patients undergoing PCI experienced significantly lower risks of NACE (HR = 0.577, p < 0.001), cardiac death (HR = 0.512, p < 0.001), myocardial infarction (HR = 0.534, p < 0.001), and all-cause mortality (HR = 0.529, p < 0.001), with no significant differences in bleeding (p = 0.461) or new-onset stroke (p = 0.639). In the CKD 1–2 group, PCI also conferred notable benefits regarding NACE (HR = 0.597, p < 0.001), cardiac death (HR = 0.423, p < 0.001), myocardial infarction (HR = 0.567, p < 0.001), and all-cause mortality (HR = 0.447, p < 0.001). Interaction analyses demonstrated statistically significant additive and multiplicative interactions for NACE (RERI = 0.052; AP = 0.085; S = 0.921; multiplicative interaction OR = 1.169; p < 0.05). Conclusion In NSTEMI patients with CKD, PCI is associated with reduced risks of NACE, cardiac death, myocardial infarction, and all-cause mortality, regardless of whether patients are in CKD stages 1–2 or 3–5. Interaction analyses suggest that PCI provides sustained and significant benefits across different CKD stages. Furthermore, as eGFR increases, the risk of NACE decreases accordingly.