Long-Term Impact of Renin-Angiotensin System Inhibitors for Secondary Prevention in Patients with Chronic Kidney Disease Who Underwent Percutaneous Coronary Intervention

Figures

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  Fig. 1.. Study flowchart. Among 4,840 patients who have undergone first intervention between 2000 and 2018, this study targeted patients who were diagnosed as CKD by the presence of either kidney damage (mainly proteinuria) or decreased kidney function (estimated GFR of <60 mL/min/1.73 m2) for three or more months. After exclusion of patients with unknown EF and receiving hemodialysis, 1,160 patients were finally analyzed. These patients were divided into two groups based on the presence or absence of RAS inhibitor use. 674 patients (58%) were allocated to the RAS inhibitor group, and 486 patients (42%) were allocated to the non-RAS inhibitor group. GFR, glomerular filtration rate; RAS, renin-angiotensin system.

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  Fig. 2.. Kaplan-Meier curves for endpoints between RAS inhibitor group and non-RAS inhibitor group. a Cumulative incidence of 3P-MACE. b Cumulative incidence of admission for HF. c Cumulative incidence of TVR. d Cumulative incidence of all-cause death. RAS, renin-angiotensin system.

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  Fig. 3.. Subgroup analysis of 3P-MACE and admission for HF. Number of events/patients, HR for 3P-MACE, and admission for HF compared between the RAS inhibitor group and the non-RAS inhibitor group, according to subgroups of age, EF, acute MI, CKD, and presence of proteinuria. GFR, glomerular filtration rate; RAS, renin-angiotensin system.

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  Fig. 4.. Long-term trends in estimated GFR between the RAS inhibitor group and the non-RAS inhibitor group. There was no significant difference for estimated GFR between the RAS inhibitor group and the non-RAS inhibitor group at the baseline (54.0 [47.5–57.7] mL/min/1.73 m2 vs. 55.0 [48.2–58.0] mL/min/1.73 m2, p = 0.128). The slope of decreased estimated GFR in the RAS inhibitor group was greater than that in the non-RAS inhibitor group, and the average percent change in estimated GFR was −14.6% in the RAS inhibitor group and −10.1% in the non-RAS inhibitor group after 5 years, showing a significant difference. GFR, glomerular filtration rate; RAS, renin-angiotensin system.