Chronic Kidney Disease Stage-specific Risk and Clinical Presentation in Left Main Coronary Intervention: Insights from the LM-JANHO Registry

The impact of chronic kidney disease (CKD) stage on outcomes after percutaneous coronary intervention (PCI) for left main (LM) coronary artery disease remains unclear. We investigated the impact of CKD stage on long-term outcomes after contemporary LM-PCI. We analyzed 756 consecutive patients who underwent LM-PCI for de novo lesion under intracoronary imaging-guidance across 19 hospitals. Patients were categorized by CKD stage: I/II (n = 360), IIIa (n = 212), IIIb (n = 105), IV (n = 40), and V (n = 39). Three-year major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, clinically driven revascularization, myocardial infarction, and cerebrovascular events, were evaluated. Patients with CKD stage IIIb or worse had higher comorbidity burdens than those with CKD I/II, including high age, hypertension, peripheral artery disease, and reduced left ventricular ejection fraction. Patients with CKD-IIIb and -IV presented more acute coronary syndrome and required mechanical circulatory support, whereas these frequencies in CKD-V were similar as in CKD-I/II. In contrast, CKD V patients exhibited greater lesion complexity, with more true bifurcation lesion and calcified lesions needing atherectomy. MACCE rates were significantly higher in CKD IV and V (CKD-I/II: 28.9%, IIIa: 31.3%, IIIb: 35.7%, IV: 45.8%, V: 48.7%). All-cause mortality rose stepwise with worsening CKD (CKD-I/II: 8.4%, IIIa: 14.9%, IIIb: 24.2%, IV: 34.9%, V: 34.6%). Clinically driven revascularization rates did not increase with advancing CKD stage. In conclusion, advanced CKD was associated with progressively worse clinical outcomes after contemporary LM-PCI, primarily driven by increased mortality, whereas clinically driven revascularization did not increase with CKD severity despite greater lesion complexity.