What is the clinical evidence from this study?

Study design: Cohort. Population: Diabetes mellitus and coronary artery disease requiring percutaneous coronary intervention (n=887). Intervention: Chronic kidney disease vs. Without chronic kidney disease. Primary outcome: Patient-oriented composite outcome (POCO) at one year (all-cause mortality, myocardial infarction, and revascularization) (HR 1.82, 95% CI 1.07-3.12, p=<0.001).

November 23, 2016Sunhwan'giOpen Access

Impact of Chronic Kidney Disease on Clinical Outcomes in Diabetic Patients Undergoing Percutaneous Coronary Intervention in the Era of Newer-Generation Drug-Eluting Stents

Q: What are the key findings of this study?

In diabetic patients undergoing PCI with newer-generation DES, chronic kidney disease independently predicted a higher risk of the 1-year patient-oriented composite outcome (HR 1.82).

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Key result

CKD is linked to an ~82% higher 1-year major event risk in diabetics undergoing PCI.

HR 1.82
95% CI 1.07-3.12
P<0.001
n=887

Why the study?

Does the presence of chronic kidney disease worsen clinical outcomes in diabetic patients undergoing percutaneous coronary intervention with newer-generation drug-eluting stents?

Population

887 consecutive patients with diabetes mellitus undergoing percutaneous coronary intervention with…

Comparison

Presence of chronic kidney disease, defined as… vs Absence of chronic kidney disease

Design

Cohort

Follow-up

one year

Authors

DTDipti Ranjan TripathyGauhati Medical College and Hospital SPSang Wook ParkChonnam National University BPBonil ParkYonsei University

Discussion

Member takes

Implication

CKD independently predicts worse patient-oriented outcomes after newer-generation DES PCI in DM; leaves open whether intensified risk modification improves prognosis.

Study Design

Type

Cohort (n=887)

Multicenter

Structured PICO

Does the presence of chronic kidney disease worsen clinical outcomes in diabetic patients undergoing percutaneous coronary intervention with newer-generation drug-eluting stents?

Population

887 diabetic patients undergoing percutaneous coronary intervention with newer-generation drug-eluting stents, followed for 1 year to assess the impact of chronic kidney disease.

Exposure

Presence of chronic kidney disease (CKD), defined as estimated creatinine clearance (eCcr) <60 mL/min/1.73 m2

Comparator

Absence of chronic kidney disease (normal renal function, eCcr ≥60 mL/min/1.73 m2)

Outcome

Patient-oriented composite outcome (POCO) including all-cause mortality, myocardial infarction (MI), and revascularization at one year following the index procedure among survivors at dischargecomposite

Main Result

Hazard Ratio: 1.82 (95% CI 1.07–3.12)

Absolute Event Rate: 14% vs 5.4%

p-value: p=<0.001

In diabetic patients undergoing PCI with newer-generation DES, concomitant CKD independently predicts worse patient-oriented outcomes (mortality, MI, revascularization) but not device-oriented outcomes.

Limitations

Single-center study with a modest number of patients and relatively short follow-up period
Low incidence of endpoints limiting evaluation of rare endpoints like stent thrombosis
Cockcroft-Gault equation might overestimate creatinine clearance in obese patients and is not applicable in end-stage renal disease
Heterogeneities in clinical and angiographic characteristics between groups despite multivariate adjustment
Single-center study with a modest number of patients and a relatively short follow-up period, with a relatively low incidence of endpoints
Cockcroft-Gault equation used for estimation of creatinine clearance might overestimate creatinine clearance in obese patients and is not applicable in patients with end-stage renal disease
Heterogeneities in clinical and angiographic characteristics between patients with or without CKD

Cite This Study

Tripathy et al. (2016) conducted a cohort in Diabetes mellitus and coronary artery disease requiring percutaneous coronary intervention (n=887). Chronic kidney disease vs. Without chronic kidney disease was evaluated on Patient-oriented composite outcome (POCO) at one year (all-cause mortality, myocardial infarction, and revascularization) (HR 1.82, 95% CI 1.07-3.12, p=<0.001). In diabetic patients undergoing PCI with newer-generation DES, chronic kidney disease independently predicted a higher risk of the 1-year patient-oriented composite outcome (HR 1.82).

synapsesocial.com/papers/6aa155ea99764889417c56d9 https://doi.org/10.4070/kcj.2016.0312

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Implication

CKD independently predicts worse patient-oriented outcomes after newer-generation DES PCI in DM; leaves open whether intensified risk modification improves prognosis.

Impact of Chronic Kidney Disease on Clinical Outcomes in Diabetic Patients Undergoing Percutaneous Coronary Intervention in the Era of Newer-Generation Drug-Eluting Stents

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Impact of Chronic Kidney Disease on Clinical Outcomes in Diabetic Patients Undergoing Percutaneous Coronary Intervention in the Era of Newer-Generation Drug-Eluting Stents

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider