CKD increases risk for MACE, death in women undergoing PCI with DES

In women undergoing PCI with drug-eluting stents, coexisting chronic kidney disease is associated with an increased long-term risk for MACE and death, according to recent findings.

Usman Baber, MD, MSc, of the Icahn School of Medicine at Mount Sinai, and colleagues evaluated pooled data on 4,217 women enrolled in 26 randomized trials. Patients identified for inclusion underwent PCI with DES and had available data on baseline creatinine. The researchers stratified the study population by creatinine clearance (CrCl): CrCl < 45 mL/min; CrCl between 45 mL/min and 59 mL/min; and CrCl ≥ 60 mL/min.

The primary endpoint was the effect of impaired kidney function on the 3-year risk for MACE, defined as the composite of all-cause mortality, target lesion revascularization or stent thrombosis. The researchers then analyzed the risk of device-oriented safety endpoints (cardiac death, MI or stent thrombosis) based on the use of new-generation DES vs. early-generation DES.

In the conversion from normal renal function (CrCl < 45 mL/min) to severely impaired renal function (CrCl ≥ 60 mL/min), the researchers observed a significant stepwise increase in 3-year rates of the following: MACE (12.9% normal function vs. 15.8% moderately impaired vs. 26.6% severely impaired; P < .01); all-cause mortality (3.1% vs. 6.4% vs. 16.1%; P < .01); cardiac death (3.1% vs. 6.4% vs. 16.1%; P < .01); MI (5.2% vs. 6.3% vs. 10.2%; P < .01); and the composite of death, MI or stent thrombosis (8% vs. 11.1% vs. 22.4%; P < .01). No differences were observed between the groups in the rates of 3-year TLR (6.4% vs. 6.1% vs. 6.8%; P = .77).

After adjustment for baseline confounding factors, severe impairment was independently linked to an increased risk for MACE (adjusted HR = 1.56; 95% CI, 1.23-1.98), all-cause mortality (adjusted HR = 2.67; 95% CI, 1.85-3.85), cardiac mortality (adjusted HR = 2.75; 95% CI, 1.65-4.61), MI (adjusted HR = 1.33; 95% CI, 0.9-1.97) and the composite of death, MI or stent thrombosis (adjusted HR = 1.85; 95% CI, 1.4-2.44) vs. normal kidney function or moderate renal impairment. Additionally, a trend toward increased risk for stent thrombosis was seen in patients categorized as having severe renal impairment (adjusted HR = 1.54; 95% CI, 0.7-3.39).

In the unadjusted analysis of new-generation DES vs. early generation in women with chronic kidney disease (CKD), the researchers found that new-generation DES were linked to lower 2-year rates of the composite of cardiac death, MI or stent thrombosis, as well as cardiac death. Multivariable adjustment for baseline confounders revealed an association between new-generation DES in women with CKD and a decrease in cardiac death, MI or stent thrombosis.

“CKD is a common comorbidity among women with CAD undergoing percutaneous revascularization with DES. Impaired renal function is associated with a strong, dose-dependent effect on the long-term risk of MACE and mortality,” the researchers wrote. “Compared with early-generation DES, use of newer-generation DES is associated with consistent and uniform benefits in women with or without CKD.” – by Jennifer Byrne
Disclosure: Baber reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.

Source: www.healio.com