Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry.
OBJECTIVES
The purpose of this study was to evaluate the clinical impact of chronic kidney disease (CKD) on clinical outcomes in contemporary practice of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES).


BACKGROUND
Although second-generation DES have improved the safety and efficacy issues in PCI, data regarding the performance of second-generation DES in patients with CKD are still limited.


METHODS
We performed a patient-level pooled analysis on 12,426 patients undergoing PCI using second-generation DES from the Korean Multicenter Drug-Eluting Stent Registry. Endpoints were stent-oriented outcomes (target lesion failure [TLF]) and patient-oriented composite outcomes (POCO) during a median follow-up of 35 months. CKD patients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal disease patients, and by the coexistence of diabetes mellitus (DM).


RESULTS
A total of 2,927 patients had CKD (23.6%), who showed a significantly higher risk of TLF (adjusted hazard ratio [HRadjust]: 1.50; 95% confidence interval [CI]: 1.21 to 1.86) and POCO (HRadjust 1.34; 95% CI: 1.17 to 1.55) compared to patients with preserved renal function. Stratified analysis by eGFR showed that TLF was not increased in the mild to moderate CKD, whereas severe CKD and dialysis-dependent patients showed significantly higher risk of TLF (HRadjust 2.44; 95% CI: 1.54 to 3.86; HRadjust 3.58; 95% CI: 2.52 to 5.08, respectively). The eGFR threshold of increased clinical events was 40 to 45 ml/min/1.73 m2. Among CKD patients, DM CKD patients showed a higher incidence of TLF compared to non-DM CKD patients (HRadjust: 1.82; 95% CI: 1.32 to 2.52), driven by the increase in target vessel-related events.


CONCLUSIONS
In the era of second-generation DES, CKD patients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal disease patients.
['Lee|Joo Myung|JM|', 'Kang|Jeehoon|J|', 'Lee|Euijae|E|', 'Hwang|Doyeon|D|', 'Rhee|Tae-Min|TM|', 'Park|Jonghanne|J|', 'Kim|Hack-Lyoung|HL|', 'Lee|Sang Eun|SE|', 'Han|Jung-Kyu|JK|', 'Yang|Han-Mo|HM|', 'Park|Kyung Woo|KW|', 'Na|Sang-Hoon|SH|', 'Kang|Hyun-Jae|HJ|', 'Koo|Bon-Kwon|BK|', 'Kim|Hyo-Soo|HS|']
D000368:Aged D015897:Comorbidity D003324:Coronary Artery Disease D003920:Diabetes Mellitus D054855:Drug-Eluting Stents D005260:Female D005919:Glomerular Filtration Rate D006801:Humans D053208:Kaplan-Meier Estimate D007668:Kidney D007676:Kidney Failure, Chronic D008297:Male D008875:Middle Aged D062645:Percutaneous Coronary Intervention D016016:Proportional Hazards Models D011474:Prosthesis Design D012042:Registries D006435:Renal Dialysis D051436:Renal Insufficiency, Chronic D056910:Republic of Korea D018570:Risk Assessment D012307:Risk Factors D012720:Severity of Illness Index D013997:Time Factors D016896:Treatment Outcome
chronic kidney disease clinical outcomes percutaneous coronary intervention chronic renal failure coronary artery disease drug-eluting stent(s)