Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry

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• 作者：Joo Myung Lee ; MD ; MPH ; PhD^a ; Jeehoon Kang ; MD^b ; ^c ; Euijae Lee ; MD^b ; Doyeon Hwang ; MD^b ; Tae-Min Rhee ; MD^b ; Jonghanne Park ; MD ; PhD^b ; Hack-Lyoung Kim ; MD ; PhD^d ; Sang Eun Lee ; MD ; PhD^b ; Jung-Kyu Han ; MD ; PhD^b ; Han-Mo Yang ; MD ; PhD^b ; Kyung Woo Park ; MD ; PhD^b ; Sang-Hoon Na ; MD ; PhD^e ; ^f ; Hyun-Jae Kang ; MD ; PhD^b ; Bon-Kwon Koo ; MD ; PhD^b ; ^f ; Hyo-Soo Kim ; MD ; PhD^b ; ^c ; ^{hyosoo@snu.ac.kr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：coronary artery disease ; chronic kidney disease ; chronic renal failure ; clinical outcomes ; drug-eluting stent(s) ; percutaneous coronary intervention
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：24 October 2016
• 年：2016
• 卷：9
• 期：20
• 页码：2097-2109
• 全文大小：2212 K

文摘

The purpose of this study was to evaluate the clinical impact of chronic kidney disease (CKD) on clinical outcomes in contemporary practice of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES).

Background

Although second-generation DES have improved the safety and efficacy issues in PCI, data regarding the performance of second-generation DES in patients with CKD are still limited.

Methods

We performed a patient-level pooled analysis on 12,426 patients undergoing PCI using second-generation DES from the Korean Multicenter Drug-Eluting Stent Registry. Endpoints were stent-oriented outcomes (target lesion failure [TLF]) and patient-oriented composite outcomes (POCO) during a median follow-up of 35 months. CKD patients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal disease patients, and by the coexistence of diabetes mellitus (DM).

Results

A total of 2,927 patients had CKD (23.6%), who showed a significantly higher risk of TLF (adjusted hazard ratio [HR_adjust]: 1.50; 95% confidence interval [CI]: 1.21 to 1.86) and POCO (HR_adjust 1.34; 95% CI: 1.17 to 1.55) compared to patients with preserved renal function. Stratified analysis by eGFR showed that TLF was not increased in the mild to moderate CKD, whereas severe CKD and dialysis-dependent patients showed significantly higher risk of TLF (HR_adjust 2.44; 95% CI: 1.54 to 3.86; HR_adjust 3.58; 95% CI: 2.52 to 5.08, respectively). The eGFR threshold of increased clinical events was 40 to 45 ml/min/1.73 m². Among CKD patients, DM CKD patients showed a higher incidence of TLF compared to non-DM CKD patients (HR_adjust: 1.82; 95% CI: 1.32 to 2.52), driven by the increase in target vessel–related events.

Conclusions

In the era of second-generation DES, CKD patients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal disease patients.