CKD tied to higher odds of MACE after EES implantation

  • Miyazaki T & al.
  • Catheter Cardiovasc Interv
  • 4 Feb 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Chronic kidney disease (CKD) is an independent predictor of major adverse cardiac events (MACE) at 5 years after implantation of an everolimus-eluting stent (EES; Xience V and/or Promus).
  • EES implantation was effective and safe; rates of ischemia-driven target lesion revascularization (ID-TLR) and stent thrombosis (ST) were similar vs non-CKD patients.

Why this matters

  • Limited data exist on safety and efficacy of second-generation drug-eluting stents in patients with preexisting CKD.

Study design

  • Tokyo-MD PCI observational, multicenter study subanalysis, comparing outcomes for patients with CKD (n=316) and without (n=1424) after EES implantation.
  • MACE defined as a composite of death, nonfatal myocardial infarction (MI), ID-TLR, and ST.
  • Funding: None disclosed.

Key results

  • Mean and median follow-up were 1391±557 and 1769 (interquartile range, 1012-1800) days, respectively.
  • Patients with CKD had significantly higher 5-year rates of all-cause death (20.1% vs 8.2%; P<.001 cardiac death vs p=".007)," mace stroke and major bleeding>
  • 5-year rates were similar with/without CKD for nonfatal MI (2.9% vs 3.3%; P=.68), ID-TLR (4.9% vs 3.7%; P=.26), and ST (0.5% vs 1.0%; P=.20).
  • In multivariate analysis, CKD was tied to a 22% increased risk for MACE (HR=1.22; P=.01).

Limitations

  • Retrospective design.
  • Nonstratified CKD.