Key result
A 30 mL/min/1.73 m2 eGFR decrement is linked to ~116% higher 10-year mortality post-PCI.
Why the study?
Limited evidence exists regarding the association of chronic kidney disease with long-term outcomes following PCI.
Does impaired kidney function increase 10-year all-cause mortality in patients with coronary artery disease undergoing percutaneous coronary intervention?
Cohort (n=5,571)
Does impaired kidney function increase 10-year all-cause mortality in patients with coronary artery disease undergoing percutaneous coronary intervention?
Effect estimate: adjusted HR 2.16 (95% CI 1.84 to 2.54)
p-value: p=< 0.001
In patients undergoing PCI, impaired kidney function is strongly associated with increased 10-year all-cause mortality, with a more pronounced effect in younger patients and those presenting with acute coronary syndromes.
Background: Limited evidence exists regarding the association of chronic kidney disease (CKD) with long-term outcomes following percutaneous coronary intervention (PCI). We aimed to assess the association of CKD with 10-year outcome after PCI. Methods: This study included 5571 patients with coronary artery disease (CAD) undergoing PCI. Patients were categorized in groups according to the estimated glomerular filtration rate (eGFR) values: eGFR ≥ 90 mL/min/1.73 m2, (normal kidney function), 60 to <90 mL/min/1.73 m2 (mild kidney impairment), 30 to <60 mL/min/1.73 m2 (mild-to-moderate and moderate-to-severe kidney impairment) and <30 mL/min/1.73 m2 (severe kidney impairment). The primary endpoint was all-cause mortality at 10 years. Results: All-cause deaths occurred in 155 patients (86.3%) with eGFR < 30 mL/min/1.73 m2, 602 patients (59.1%) with eGFR 30 to <60 mL/min/1.73 m2, 775 patients (31.3%) with eGFR 60 to <90 mL/min/1.73 m2 and 220 patients (15.8%) with eGFR ≥ 90 mL/min/1.73 m2 (adjusted hazard ratio = 2.16, 95% confidence interval 1.84 to 2.54, p < 0.001, for 30 mL/min/1.73 m2 decrement in the eGFR). There were CKD-by-age (Pint < 0.001) and CKD–by-clinical presentation (Pint = 0.017) interactions showing a stronger association of CKD with mortality in younger patients and those presenting with acute coronary syndromes. The C statistic of the multivariable model for mortality increased from 0.748 [0.737–0.759] to 0.766 [0.755–0.777] (p < 0.001) after the inclusion of eGFR in the model. Conclusions: In patients with CAD undergoing PCI, CKD was associated with higher mortality at 10 years compared with patients with preserved renal function. The association between CKD and mortality was stronger in patients of younger age and those presenting with acute coronary syndromes.
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Ndrepepa et al. (2024) conducted a cohort in Coronary artery disease (CAD) undergoing PCI (n=5,571). Decreased estimated glomerular filtration rate (eGFR) vs. Preserved renal function (eGFR ≥ 90 mL/min/1.73 m2) was evaluated on All-cause mortality at 10 years (adjusted HR 2.16, 95% CI 1.84 to 2.54, p=< 0.001). A 30 mL/min/1.73 m2 decrement in eGFR was associated with a higher risk of 10-year all-cause mortality in patients undergoing PCI (adjusted HR 2.16; 95% CI 1.84-2.54; p<0.001).
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