Impact of renal failure on all-cause mortality and other outcomes in patients treated by percutaneous coronary intervention
Open accessAbstract
Background Patients with renal failure (RF) have been systematically excluded from clinical trials; consequently their outcomes have not been well studied in the setting of percutaneous coronary intervention (PCI).Aims To compare cardiovascular outcomes after contemporary PCI in patients with versus without RF, according to clinical presentation (ST-segment elevation myocardial infarction [STEMI], acute coronary syndrome [ACS] or stable coronary artery disease [sCAD]).Methods Consecutive patients undergoing PCI with stent were prospectively included from 2007 to 2012. RF was defined as creatinine clearance<60mL/min. The primary endpoint was all-cause mortality; secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE: composite of cardiovascular death, myocardial infarction, stroke and target lesion revascularization [TLR]), TLR and Academic Research Consortium definite/probable stent thrombosis (ST) at 1 year.Results Among 5337 patients, 23% had PCI for STEMI, 34% for ACS and 43% for sCAD, while 27% had RF. RF patients had a higher unadjusted death rate than those with preserved renal function (nRF) in all PCI indication groups (STEMI, 41% vs. 7.5%; ACS, 19% vs. 6%; sCAD, 10% vs. 3%; P<0.0001 for all). The rate of MACCE was also higher in RF patients whatever the PCI indication (STEMI, 45% vs. 15%; ACS, 23% vs. 14%; sCAD, 14% vs. 9%; P<0.05 for all). Rates of TLR (5.5-7.4%) and ST (<2.5%) were similar (P>0.05 for both). sCAD-RF and STEMI-nRF patients had similar rates of mortality (P=0.209) and MACCE (P=0.658). RF was independently associated with mortality, with a doubled relative risk in STEMI versus ACS and sCAD groups (odds ratio 5.3, 95% confidence interval 3.627-7.821 vs. 2.1, 1.465-3.140 and 2.3, 1.507-3.469, respectively; P<0.0001).Conclusion RF is a stronger independent predictor of death after PCI in STEMI than in ACS or sCAD patients. sCAD-RF and STEMI-nRF patients had similar prognoses.
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A reduction in heart failure hospitalizations and a small reduction in myocardial infarction were observed in a pooled analysis of the CORONA and GISSI-HF trials.
“a reduction in HF hospitalizations [218,471], as well as a small reduction in MI, was observed in a pooled analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA) and GISSI-HF trials [472].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [472]
Patients with CKD and established CVD have a much higher mortality rate compared with patients with CVD and normal renal function.
“Patients with CKD and established CVD have a much higher mortality rate compared with patients with CVD and normal renal function. 392”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [392]
Patients with stage 3-5 chronic kidney disease are at high or very high cardiovascular risk.
“Patients with stage 3-5 CKD have to be considered at high or very high CV risk.”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [392]
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- Authors
- Loncar, G., Barthelemy, O., Berman, E., Kerneis, M., Petroni, T., Payot, L., Choussat, R., Silvain, J., Collet, J.-P., Helft, G., Montalescot, G., & Le Feuvre, C.
- Affiliations
- Assistance Publique – Hôpitaux de Paris (FR)
- Venue
- Archives of Cardiovascular Diseases
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 108
- Issue
- 11
- Pages
- 554-562
- ISSN
- 1875-2128 (ISSN-L)
- 1875-2136
- OpenAlex
- W1544272996
- Cited by
- 17
- References
- 28
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 4 · 2019: 3 · 2018: 3 · 2016: 4 · 2015: 1
- FWCI
- 2.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Archives of cardiovascular diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fondation de France
- AstraZeneca
- Biotronik
- Institut National de la Santé et de la Recherche Médicale
- Société Française de Cardiologie
- Eli Lilly and Company
- Fédération Française de Cardiologie
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- renal failure, percutaneous coronary intervention, all-cause mortality, major adverse cardiac and cerebrovascular events, ST-elevation myocardial infarction, acute coronary syndrome, stable coronary artery disease, target lesion revascularization, stent thrombosis, renal function, creatinine clearance, stenting, myocardial infarction
- MeSH terms
- Aged, Cause of Death, Coronary Artery Disease, Female, France, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Registries, Risk Factors, Time Factors, Stents, Multivariate Analysis, Chi-Square Distribution, Logistic Models, Odds Ratio, Treatment Outcome, Myocardial Ischemia, Risk Assessment, Renal Insufficiency, Kaplan-Meier Estimate, Acute Coronary Syndrome, Percutaneous Coronary Intervention
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