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In-Hospital and 1-Year Outcomes Among Percutaneous Coronary Intervention Patients With Chronic Kidney Disease in the Era of Drug-Eluting Stents

A Report From the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) Registry

Faisal Latif, MD^_*, Neal S. Kleiman, MD, David J. Cohen, MD, MSc, Michael J. Pencina, PhD, Chen-Hsing Yen, MS, Donald E. Cutlip, MD, David J. Moliterno, MD^||, Deborah Nassif, PhD, John J. Lopez, MD^¶, Jorge F. Saucedo, MD^_*,_* on behalf of the EVENT Investigators

^_* University of Oklahoma, Oklahoma City, Oklahoma
Methodist DeBakey Heart Center, Houston, Texas
Saint Luke's Mid America Heart Institute, Kansas City, Missouri
Harvard Clinical Research Institute, Boston, Massachusetts
^|| University of Kentucky, Lexington, Kentucky
^¶ University of Chicago, Chicago, Illinois

^_* Reprint requests and correspondence: Dr. Jorge F. Saucedo, 920 Stanton L. Young Boulevard, WP 3010, Oklahoma City, Oklahoma 73104 (Email: Jorge-Saucedo{at}ouhsc.edu).

Objectives: This study sought to evaluate ischemic and bleeding outcomes in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).

Background: Previous studies have shown that CKD is associated with poor outcomes after PCI. However, these studies were largely conducted before the introduction of DES and aggressive antithrombotic therapy or were performed in the setting of randomized trials. With data from a contemporary registry, we evaluated the influence of CKD on major cardiovascular events and bleeding complications in unselected "real-world" patients undergoing PCI.

Methods: Data from 4,791 patients enrolled in the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) Registry between July 2004 and September 2005 were analyzed. Patients were stratified into 4 groups: creatinine clearance (CrCl) >75, 50 to 75, 30 to 49 and <30 ml/min.

Results: During the index hospital stay, there was a step-wise increase in bleeding complications with decreasing CrCl (3.3%, 5.0%, 8.8%, and 14.3%; p < 0.0001 for trend). Lower CrCl was also associated with more frequent death or myocardial infarction (MI) during the initial hospital stay (p = 0.001) and at 1 year (p < 0.001). These findings were confirmed in multivariate analyses that adjusted for baseline differences in demographic, clinical, and angiographic factors. Use of guideline-recommended medications at 1 year, including aspirin, clopidogrel, angiotensin-converting enzyme inhibitors, and statins, also decreased with declining renal function.

Conclusions: Renal function is an independent and powerful predictor of bleeding and ischemic complications in the era of DES and contemporary antithrombotic therapy in patients undergoing PCI. The low use of guideline-recommended drugs among patients with CKD undergoing PCI might contribute to these adverse outcomes and warrants further evaluation.

Key Words: angioplasty • chronic kidney disease • coronary disease • drug-eluting stents

Abbreviations and Acronyms   ACS = acute coronary syndrome   CK = creatine kinase   CK-MB = creatine kinase-myocardial band   CKD = chronic kidney disease   CrCl = creatinine clearance   DES = drug-eluting stent(s)   DTI = direct thrombin inhibitor   GP = glycoprotein   MI = myocardial infarction   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction   TLR = target lesion revascularization

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