Division of Cardiology and Nephrology, Albany Medical College, Albany, New York.
Tex Heart Inst J. 2022 Sep 1;49(5). doi: 10.14503/THIJ-21-7670.
Patients with chronic kidney disease are underrepresented in registries and in randomized trials of coronary artery disease management. To investigate effects of chronic kidney disease on outcomes of nonemergent percutaneous coronary intervention in patients with left main or left main-equivalent coronary artery disease, we analyzed data from the New York State Percutaneous Coronary Intervention Registry during the calendar year 2015, involving 2,956 elective percutaneous coronary intervention cases. Outcomes of percutaneous coronary intervention in patients with various degrees of chronic kidney disease and stable left main or left main-equivalent coronary artery disease were compared.
Only patients with left main or left main-equivalent coronary artery disease and elective percutaneous coronary intervention were included in the study cohort. Patients with acute coronary syndromes within 24 hours of the index percutaneous coronary intervention, patients reported to be in shock, and patients with prior coronary artery bypass surgery were excluded from the study cohort.
In this cohort, stage 4 or 5 chronic kidney disease, current congestive heart failure, and left main disease remained statistically significant predictors of post-percutaneous coronary intervention mortality.
Our findings in this large, statewide cohort indicate that advanced kidney disease is associated with markedly increased post-nonemergent percutaneous coronary intervention mortality.
慢性肾脏病患者在注册研究和冠状动脉疾病管理的随机试验中代表性不足。为了研究慢性肾脏病对左主干或左主干等效冠状动脉疾病患者非紧急经皮冠状动脉介入治疗结局的影响，我们分析了 2015 年纽约州经皮冠状动脉介入治疗注册研究的数据，涉及 2956 例选择性经皮冠状动脉介入治疗病例。比较了不同程度慢性肾脏病和稳定左主干或左主干等效冠状动脉疾病患者经皮冠状动脉介入治疗的结局。
仅纳入左主干或左主干等效冠状动脉疾病和选择性经皮冠状动脉介入治疗的患者作为研究队列。排除了在指数经皮冠状动脉介入治疗后 24 小时内发生急性冠状动脉综合征、报告休克的患者和有既往冠状动脉旁路移植术的患者。
在该队列中，慢性肾脏病 4 或 5 期、充血性心力衰竭和左主干疾病仍然是经皮冠状动脉介入治疗后死亡率的统计学显著预测因素。
我们在这个大型全州范围内队列中的发现表明，晚期肾脏病与非紧急经皮冠状动脉介入治疗后死亡率显著增加相关。
