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Impact of Chronic Kidney Disease on Cardiovascular and Renal Events in Patients Undergoing Percutaneous Coronary Intervention with Everolimus-Eluting Stent: Risk Stratification with C-Reactive Protein.

ABSTRACT: BACKGROUND:Chronic kidney disease (CKD) and inflammation play critical roles in atherosclerosis. There is limited evidence regarding the relationship between CKD and patients receiving second-generation drug-eluting stents for coronary artery disease. OBJECTIVE:This study aimed to investigate the effect of CKD on cardiovascular and renal events in patients undergoing percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES). METHODS:We analyzed 504 consecutive patients with stable angina pectoris and significant coronary artery stenosis treated with EES. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 before coronary angiography. The primary outcome was the occurrence of major adverse renal and cardiovascular events (MARCE) including cardiac death, revascularization, heart failure, cerebral infarction, worsening renal function > 25% from baseline, and renal replacement therapy at 1 year. RESULTS:Patients were divided into the a MARCE (n = 126) and a non-MARCE (n = 378) group. The incidence of CKD was 51% in all subjects (including those on hemodialysis) and was significantly higher in the MARCE group than in the non-MARCE group (p = 0.00001). Multivariate logistic regression analysis identified that CKD was independently associated with MARCE (adjusted odds ratio 2.03, 95% confidence interval 1.21-3.39, p = 0.007). Patients were divided into four groups based on CKD and C-reactive protein (CRP) level prior to initial coronary angiography. Cox proportional hazards analysis revealed that patients with CKD and high CRP (?0.3 mg/dL) had the worst prognosis (hazard ratio 4.371, 95% confidence interval 2.634-7.252, p = 0.00001) compared to patients without CKD and with low CRP. CONCLUSION:CKD combined with CRP predicted more clinical events in patients undergoing PCI with EES.

SUBMITTER: Dan K

PROVIDER: S-EPMC5968296 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Impact of Chronic Kidney Disease on Cardiovascular and Renal Events in Patients Undergoing Percutaneous Coronary Intervention with Everolimus-Eluting Stent: Risk Stratification with C-Reactive Protein.

Dan Kazuhiro K Miyoshi Toru T Nakahama Makoto M Mizuno Tomofumi T Kagawa Kenzo K Naito Yoichiro Y Kawada Satoshi S Ito Hiroshi H

Cardiorenal medicine 20180327 2

<h4>Background</h4>Chronic kidney disease (CKD) and inflammation play critical roles in atherosclerosis. There is limited evidence regarding the relationship between CKD and patients receiving second-generation drug-eluting stents for coronary artery disease.<h4>Objective</h4>This study aimed to investigate the effect of CKD on cardiovascular and renal events in patients undergoing percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES).<h4>Methods</h4>We analyzed 504 conse ...[more]

PMID: 29617004

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Project description:ObjectivesTo examine the safety and effectiveness of cobalt-chromium everolimus eluting stents compared with bare metal stents.DesignIndividual patient data meta-analysis of randomised controlled trials. Cox proportional regression models stratified by trial, containing random effects, were used to assess the impact of stent type on outcomes. Hazard ratios with 95% confidence interval for outcomes were reported.Data sources and study selectionMedline, Embase, the Cochrane Central Register of Controlled Trials. Randomised controlled trials that compared cobalt-chromium everolimus eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients.Primary outcomesThe primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite or probable stent thrombosis, target vessel revascularisation, and all cause death.ResultsThe search yielded five randomised controlled trials, comprising 4896 participants. Compared with patients receiving bare metal stents, participants receiving cobalt-chromium everolimus eluting stents had a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P<0.001), and target vessel revascularisation (0.29, 0.20 to 0.41; P<0.001) at a median follow-up of 720 days. There was no significant difference in all cause death between groups (0.83, 0.65 to 1.06; P=0.14). Findings remained unchanged at multivariable regression after adjustment for the acuity of clinical syndrome (for instance, acute coronary syndrome v stable coronary artery disease), diabetes mellitus, female sex, use of glycoprotein IIb/IIIa inhibitors, and up to one year v longer duration treatment with dual antiplatelets.ConclusionsThis meta-analysis offers evidence that compared with bare metal stents the use of cobalt-chromium everolimus eluting stents improves global cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis.

Dataset Information

Impact of Chronic Kidney Disease on Cardiovascular and Renal Events in Patients Undergoing Percutaneous Coronary Intervention with Everolimus-Eluting Stent: Risk Stratification with C-Reactive Protein.

Publications

Impact of Chronic Kidney Disease on Cardiovascular and Renal Events in Patients Undergoing Percutaneous Coronary Intervention with Everolimus-Eluting Stent: Risk Stratification with C-Reactive Protein.

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