Introduction Patients with chronic kidney disease (CKD) have been excluded from clinical trials evaluating the outcomes of percutaneous coronary intervention (PCI). Although studies show that CKD increases complications in patients undergoing PCI, there is still uncertainty of the long term efficacy of PCI for patients with this common problem.
Purpose To describe and compare the outcomes of patients with varying degrees of CKD following PCI and to determine in what time period they are most at risk of complications.
Method 1862 patients received PCI in our centre from June 2016 to June 2018, 130 of which had renal failure. We retrospectively compared the complication rates between two groups of patients, those who were on dialysis (44) and those with CKD stage 3 and 4 and not on dialysis (86). Baseline characteristics of the patients were evaluated and patient records were reviewed to observe their outcome at 1 month and 6 months. We defined MACE as cardiovascular death, MI, stroke, major bleeding complication and cardiac arrest.
Results Comparing the baseline characteristics there was no significant difference in mean age between the dialysis group vs the CKD stage3/4 group (67 vs 70). However, there was a higher proportion of men in the CKD stage 3/4 group vs the dialysis cohort (84% vs 59%, p<0.05). There was a significantly higher proportion of diabetics in the dialysis vs the CKD stage 3/4 group (70% vs 55%, P<0.05). Comparing outcomes at 1 month between those on dialysis and those with CKD stage 3/4, dialysed patients had a numerically higher MACE (15.9% vs 11.6%, p>0.05) and all-cause mortality (13.6% vs 9.3%, p>0.05), however, neither were significantly different. At 6 months, the dialysis group had a significantly higher MACE than the CKD stage 3/4 group (34.1% vs 12.8%, P<0.01). The dialysis group also had significantly higher all-cause mortality (25% vs 12.6% p<0.05).
Conclusion Patients with chronic kidney disease undergoing PCI have a high morbidity and mortality rate. When we split the groups, patients on dialysis have a worse outcome with higher morbidity and mortality at 6 months compared to those with CKD stage 3/4 and not on dialysis. The period of highest risk for MACE extended throughout the 6 months in the dialysis cohort, whereas, those not on dialysis were at highest risk in the first month. The outcomes at 6 months can be seen in table 1.
Conflict of Interest No conflict of interest for all authors
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