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Chronic kidney disease (CKD) and inflammation play critical roles in atherosclerosis. There is limited evidence regarding the relationship between CKD and patients receiving second-generation drug-eluting stents for coronary artery disease. This study aimed to investigate the effect of CKD on cardiovascular events in patients undergoing percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES).
We analyzed 504 consecutive patients with stable angina pectoris and significant coronary artery stenosis treated with EES. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73m2 before coronary angiography. The primary outcome was the occurrence of major adverse cardio-cerebrovascular events (MACCE) including cardiac death, revascularization, heart failure, and stroke at 1 year.
MACCE were identified in 21.8% of all patients. Patients were divided into the MACCE (n=110) and non-MACCE (n=394) groups. The incidence of CKD was 51% in all subjects, and it was significantly higher in the MACCE group than in the non-MACCE group (p<0.01). Multivariate logistic regression analysis identified that CKD was independently associated with MACCE (adjusted odds ratio, 2.18; 95% confidence interval, 1.34-3.53; p<0.01). Patients were divided into four groups based on CKD and C-reactive protein (CRP) level prior to initial coronary angiogram. Cox proportional hazards analysis revealed that patients with CKD and high CRP (≥0.3 mg/dl) had the worst prognosis (hazard ratio, 4.564; 95%CI, 2.539-8.032; p<0.01) compared to patients with non CKD and low CRP. Furthermore, the ratio of in-stent restenosis using the EES rate was 3.8% with intravascular ultrasound imaging guidance as general routine practice in Japan. This rate was not different in patients with versus without CKD. Stent thrombosis was not identified in this 1 year follow-up study, which included some patients with hemodialysis (5.6% of the study population).
CKD predicted more clinical events in patients undergoing PCI with EES. Among patients with CKD, risk was stratified according to CRP.
OTHER: Renal Insufficiency and Contrast Nephropathy