Dose-dependent effect of impaired renal function on all-cause mortality in patients following percutaneous coronary intervention

Objective: To determine the risk prediction of various degrees of impaired renal function on all-cause mortality in patients following percutaneous coronary intervention (PCI).

Background: Patients with chronic kidney disease (CKD) are at high risk of all-cause mortality after PCI. However, there are less data of various degrees of impaired renal function to predict those risks.

Methods: This was a subgroup analysis of nationwide PCI registry of 22 045 patients. Patients were classified into six CKD stages according to preprocedure estimated glomerular filtration rate (eGFR) (ml/min/1.73 m² ): I (≥90), II (60-89), III (30-59), IV (15-29), or V (<15) without or with dialysis. Baseline clinical and angiographic characteristics were compared among patients in each stage. One-year all-cause mortality was reported with risk prediction based on CKD stages and other risk factors.

Results: Patients with CKD stage I-V without and with on dialysis were found in 26.9%, 40.8%, 23.2%, 3.9%, 1.5%, and 3.7%, respectively. PCI procedural success and complication rates ranged from 94.0% to 96.2% and 2.8% to 6.1%, respectively. One-year overall survival among CKD stages I-V was 96.3%, 93.1%, 84.4%, 65.2%, 68.0%, and 69.4%, respectively (p < .001 by log-rank test). After adjusting covariables, the hazard ratios of all-cause mortality for CKD stages II-V as compared to stage I by multivariate Cox regression analysis were 1.5, 2.6, 5.3, 5.9, and 7.0, respectively, (p < .001).

Conclusion: Among patients undergoing PCI, lower preprocedure eGFR is associated in a dose-dependent effect with decreased 1-year survival. This finding may be useful for risk classification and to guide decision-making.