Impact of Chronic Kidney Disease on Clinical Outcomes in Diabetic Patients Undergoing Percutaneous Coronary Intervention in the Era of Newer-Generation Drug-Eluting Stents.
- Author:
Su Min KIM
1
;
Dipti Ranjan TRIPATHY
;
Sang Wook PARK
;
Bonil PARK
;
Jung Woo SON
;
Jun Won LEE
;
Young Jin YOUN
;
Sung Gyun AHN
;
Min Soo AHN
;
Jang Young KIM
;
Byung Su YOO
;
Seung Hwan LEE
;
Junghan YOON
Author Information
- Publication Type:Original Article
- Keywords: Chronic kidney disease; Diabetes mellitus; Drug-eluting stent; Percutaneous coronary intervention; Prognosis
- MeSH: Death; Diabetes Mellitus; Drug-Eluting Stents*; Follow-Up Studies; Hospitalization; Humans; Incidence; Mortality; Multivariate Analysis; Myocardial Infarction; Percutaneous Coronary Intervention*; Prognosis; Renal Insufficiency, Chronic*; Survivors
- From:Korean Circulation Journal 2017;47(2):222-230
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) is known to be a major adverse predictor in diabetes mellitus (DM) patients undergoing percutaneous coronary intervention (PCI). It is expected that the use of newer-generation drug-eluting stents (DES) would improve clinical outcomes in these patients. We evaluated the impact of CKD on clinical outcomes in diabetic patients undergoing PCI using newer-generation DES in a real-world setting. SUBJECTS AND METHODS: A total of 887 patients who underwent PCI with newer-generation DES and who had a history of DM or HbA1c >6.5% at the time of hospitalization were analyzed. These patients were divided into groups without CKD (n=549) and with CKD (n=338). Among survivors at discharge, a patient-oriented composite outcome (POCO) including all-cause mortality, myocardial infarction (MI), and revascularization was evaluated, together with a device-oriented composite outcome (DOCO) including cardiac death, target vessel-related MI, and target lesion revascularization at a follow-up period of one year. RESULTS: The incidence of POCO (5.4% vs. 14.0%, log-rank p<0.001) and DOCO (1.1% vs. 4.1%, log-rank p<0.001) was higher in patients with CKD. According to multivariate analysis, which was adjusted for baseline differences in demographic, clinical, and angiographic factors, the presence of CKD was an independent predictor of POCO (hazard ratio [HR]: 1.82, 95% confidence interval [CI]: 1.07 to 3.12), but not of DOCO (HR 2.08, 95% CI: 0.69-6.28). CONCLUSION: In DM patients, CKD is an independent and powerful predictor of patient-related outcomes, but not of device-related outcomes in the era of newer-generation DES.
