Korean Circ J.  2017 Jan;47(1):50-55. 10.4070/kcj.2016.0093.

Impact of Chronic Kidney Disease on Long-Term Outcome in Coronary Bypass Candidates Treated with Percutaneous Coronary Intervention

Affiliations
  • 1Division of Cardiovascular, Department of Internal Medicine, Chang Gung University, Taoyuan, Taiwan. hsinfu.lee@gmail.com
  • 2Cardiovascular Intervention Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
  • 3Chang Gung University, College of Medicine, Taoyuan, Taiwan.

Abstract

BACKGROUND AND OBJECTIVES
The aim of this study was to identify clinical, lesional, and procedural predictors for adverse outcomes of coronary angioplasty and stenting in coronary bypass candidates.
SUBJECTS AND METHODS
This cohort study included 107 consecutive candidates for coronary artery bypass surgery who underwent percutaneous coronary intervention with multiple coronary stents between Jan 2004 and Dec 2011. The study endpoint was major adverse cardiovascular events (MACEs) including all-cause mortality, nonfatal myocardial infarction, repeat revascularization, and stent thrombosis. Follow up was from the date of index percutaneous coronary intervention to the date of the first MACE, date of death, or December 31, 2015, whichever came first.
RESULTS
In this study (age 62.3±11.2 years, 86% male), 38 patients (36%) had MACE. Among baseline, angiographic, and procedural parameters, there were significant differences in lower left ventricular ejection fraction (LVEF) and worse renal function. In a Cox regression model, LVEF and chronic kidney disease (CKD) were significant predictors for MACE. After a multivariate adjustment, CKD remained a significant predictor of MACEs (hazard ratio: 2.97, 95% confidence interval: 1.50-5.90).
CONCLUSIONS
For coronary bypass candidates who were treated with coronary angioplasty and stenting, CKD seems to be the strongest predictor for adverse outcomes compared with other traditional factors.

Keyword

Coronary artery disease; Coronary angioplasty, bypass surgery; Chronic kidney disease

MeSH Terms

Angioplasty
Cohort Studies
Coronary Artery Bypass
Coronary Artery Disease
Follow-Up Studies
Humans
Mortality
Myocardial Infarction
Percutaneous Coronary Intervention*
Renal Insufficiency, Chronic*
Stents
Stroke Volume
Thrombosis

Figure

  • Fig. 1 Flow chart of enrollment. CAD: coronary artery disease, CABG: coronary artery bypass graft, PCI: percutaneous coronary intervention.

  • Fig. 2 Kaplan-Meier analysis for event-free survival in patients with or without CKD. CKD: chronic kidney disease.


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