Background:
We investigated coronary artery disease (CAD) burden and rates of death and stroke in stable patients with renal insufficiency undergoing elective percutaneous coronary intervention (PCI).
Methods:
Data from 2015 NY state Angioplasty registry was utilized. There were 33,508 PCI recipients (65+/-11 years old; 32% females, 40% with diabetes, 6.4% with COPD, 6.9% with history of CHF, and 8.25% with peripheral artery disease) without history of recent myocardial infarction (MI in less than 24 hours), shock, or prior coronary artery bypass surgery. Patients were divided according to the glomerular filtration rate (GFR) status consistent with the National Kidney Foundation classification: 24% had a GFR more than 90 ml/min (group G1) , 49% GFR of 60-89 (G2), 15% GFR of 45-49 (G3a), 6.9% GFR 30-44 (G3b), 2% GFR of 15-29 (G4), and 4% with GFR of less than 15 ml/min (G5).
Results:
With decline in GFR, prevalence of CHF increased significantly. CHF was present in 3.6% of G1 patients undergoing elective PCI, 4.49% of G2, 10.20% of G3a, 17% of G3b, 22.26% of G4 and 22.20% of G5 patients (P<0.0001). With decline in GFR, CAD burden was also significantly increased. Left main or three vessel CAD was present in 19.39% of G1 patients undergoing elective PCI, 19.13% of G2, 22.62% of G3a, 25.83% of G3b, 29% of G4 and 27.8% of G5 patients (p<0.001). Furthermore, advanced kidney disease was associated with increased rates of post elective PCI stroke and death. Specifically, post PCI stroke occurred in 0.11% of G1 patients, 0.13% of G2, 0.33% of G3a, 0.27% of G3b, 0.7% of G4, and 0.6% of G5 patients (p<0.001). Similarly, post elective PCI mortality occurred in 0.16% in G1 patients, 0.19% in G2, 0.41% in G3a, 1.04% in G3b, 1.22% in G4 and 1.49% in G5 patients (p<0.0001). After adjustment for co-morbidities such as diabetes, CVD, and COPD, risk of post PCI stroke and death was significantly increased by 3.528 (95%CI 1.866-6.671, p<0.0001) in patients with GFR less than 15 ml/min.
Conclusion:
In patients undergoing elective PCI, renal insufficiency is associated with increased rates of post-procedural death and stroke as well as increased prevalence of CHF. Additional research is needed to decrease risk of elective interventions in this vulnerable group of CAD patients.
Low-Dose Unfractionated Heparin with Sequential Enoxaparin in Patients with Diabetes Mellitus and Complex Coronary Artery Disease during Elective Percutaneous Coronary Intervention