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Background <p>Chronic kidney disease (CKD) is associated with unfavorable outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). However, its prognostic role in patients undergoing complex high-risk PCI (CHIP) remains unexplored, prompting our investigation.</p> Methods <p>Consecutive CHIP patients treated at a tertiary care center from 2012 to 2022 were included in the current analysis. CHIP was identified by the presence of at least one patient and one procedural criterion from a validated score. Patients were stratified by CKD status, with CKD defined as eGFR &lt; 60&#xa0;ml/min/1.73m<sup>2</sup>. The primary endpoint was one-year incidence of major adverse cardiovascular events (MACE), including all-cause mortality, spontaneous myocardial infarction (MI), and stroke. A multivariable Cox regression model was computed adjusted for relevant baseline risk factors and comorbidities.</p> Results <p>Among 4855 CHIP patients, 39.6% (n = 1925) had CKD at baseline. CKD patients were older, with more comorbidities, and complex CAD. After multivariable adjustment, CKD was associated with increased 1-year risks of MACE (primarily driven by all-cause mortality and MI rates), and bleeding. In-hospital adjusted hazards for ischemic and bleeding events were similar between the two cohorts, while CA-AKI occurred twice as often in CKD patients compared to non-CKD ones.</p> Conclusions <p>In CHIP patients, CKD is a strong predictor of ischemic and bleeding events at one-year follow-up and doubles the risk of post-procedural CA-AKI, underscoring the need for tailored risk assessment and management of this vulnerable population.</p> Graphical abstract <p>Clinical Outcomes after Complex and High-Risk PCI According to Baseline Chronic Kidney Disease. <i>BCIS</i> British Cardiovascular Intervention Society, <i>CA-AKI</i> contrast associated acute kidney injury, <i>CHIP</i> Complex and High-Risk Indicated Percutaneous Coronary Intervention, <i>MACE</i> major adverse cardiovascular events, <i>PCI</i> percutaneous coronary intervention, <i>TVR</i> target vessel revascularization</p> <p></p>

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Clinical outcomes after complex and high-risk percutaneous coronary intervention according to baseline chronic kidney disease

  • 期刊论文

  • 发表日期：

    2025年2月25日

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  • Francesca Maria Di Muro,
  • Samantha Sartori,
  • Birgit Vogel,
  • Yihan Feng,
  • Mauro Gitto,
  • Angelo Oliva,
  • Prakash Krishnan,
  • Benjamin Bay,
  • Joseph Sweeny,
  • Pedro Moreno,
  • Parasuram Krishnamoorthy,
  • George Dangas,
  • Annapoorna Kini,
  • Samin Sharma,
  • Roxana Mehran

摘要

Background

Chronic kidney disease (CKD) is associated with unfavorable outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). However, its prognostic role in patients undergoing complex high-risk PCI (CHIP) remains unexplored, prompting our investigation.

Methods

Consecutive CHIP patients treated at a tertiary care center from 2012 to 2022 were included in the current analysis. CHIP was identified by the presence of at least one patient and one procedural criterion from a validated score. Patients were stratified by CKD status, with CKD defined as eGFR < 60 ml/min/1.73m2. The primary endpoint was one-year incidence of major adverse cardiovascular events (MACE), including all-cause mortality, spontaneous myocardial infarction (MI), and stroke. A multivariable Cox regression model was computed adjusted for relevant baseline risk factors and comorbidities.

Results

Among 4855 CHIP patients, 39.6% (n = 1925) had CKD at baseline. CKD patients were older, with more comorbidities, and complex CAD. After multivariable adjustment, CKD was associated with increased 1-year risks of MACE (primarily driven by all-cause mortality and MI rates), and bleeding. In-hospital adjusted hazards for ischemic and bleeding events were similar between the two cohorts, while CA-AKI occurred twice as often in CKD patients compared to non-CKD ones.

Conclusions

In CHIP patients, CKD is a strong predictor of ischemic and bleeding events at one-year follow-up and doubles the risk of post-procedural CA-AKI, underscoring the need for tailored risk assessment and management of this vulnerable population.

Graphical abstract

Clinical Outcomes after Complex and High-Risk PCI According to Baseline Chronic Kidney Disease. BCIS British Cardiovascular Intervention Society, CA-AKI contrast associated acute kidney injury, CHIP Complex and High-Risk Indicated Percutaneous Coronary Intervention, MACE major adverse cardiovascular events, PCI percutaneous coronary intervention, TVR target vessel revascularization