End-stage renal disease as an independent risk factor for in-hospital mortality after coronary drug-eluting stenting: Understanding and modeling the risk

Catheter Cardiovasc Interv. 2021 Aug 1;98(2):246-254. doi: 10.1002/ccd.28929. Epub 2020 May 19.

Abstract

Objectives: We sought to compare in-hospital outcomes between patients with and without end-stage renal disease (ESRD) undergoing coronary drug-eluting stent (DES) placement and to model risk of in-hospital adverse postpercutaneous coronary intervention (PCI) events in ESRD patients.

Background: The effect of ESRD on the risk of in-hospital complications after DES PCI is relatively unclear, as is the ability to prospectively stratify risk in this population.

Methods: Consecutive patients undergoing first-time DES between April 1, 2003 and June 30, 2018 at a single tertiary care hospital were included in a prospective registry. Outcomes in those with ESRD were compared to those without ESRD. The primary endpoint was in-hospital all-cause mortality; secondary endpoints included in-hospital major adverse cardiac events (MACE)-defined as cardiac death, myocardial infarction, or unplanned revascularization-and major bleeding. Multivariate logistic regression modeling was used to identify factors associated with each outcome and to generate risk scores.

Results: Among 18,134 patients in the study population, 382 (2.1%) had ESRD. ESRD was associated with increased risk of in-hospital mortality (7.1 vs. 2.9%, p < .001), in-hospital MACE (6.3 vs. 2.1%, p < .001), and major bleeding (12.0 vs. 2.6%, p < .001). After multivariable risk adjustment, ESRD was independently associated with in-hospital mortality (odds ratio: 1.83, 95% confidence interval: 1.04-3.23, p = .04) but not MACE or major bleeding. Among patients with ESRD, risks of MACE and major bleeding were successfully modeled (c-statistics = .72 and .85, respectively).

Conclusions: ESRD is independently associated with increased risk of in-hospital mortality after coronary DES. Future studies are necessary to validate risk models derived to identify high-risk ESRD patients.

Keywords: dialysis; drug-eluting stents; end-stage renal disease.

MeSH terms

  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / therapy
  • Drug-Eluting Stents*
  • Hospital Mortality
  • Humans
  • Kidney Failure, Chronic* / diagnosis
  • Kidney Failure, Chronic* / therapy
  • Percutaneous Coronary Intervention* / adverse effects
  • Pharmaceutical Preparations*
  • Prosthesis Design
  • Risk Factors
  • Treatment Outcome

Substances

  • Pharmaceutical Preparations