Nationwide trends and outcomes of percutaneous coronary intervention for stable ischemic heart disease in end-stage kidney disease: a longitudinal study

Background: Patients with end-stage kidney disease (ESKD) are at high risk for coronary artery disease. We investigate the trends and outcomes of percutaneous coronary intervention (PCI) for stable ischemic heart disease (SIHD) in patients with ESKD.

Methods: We utilized the United States Renal Data System [2010-2018] to include adult patients with ESKD on dialysis for at least 3 months who underwent PCI for SIHD. Patients with myocardial infarction during index hospitalization, history of coronary artery bypass graft or renal transplantation and without Medicare AB coverage were excluded. Trends and related outcomes, including mortality and revascularization rate, were studied.

Results: The mean age was 65.1 years with 57.5% male and a majority White (64.5%). The dialysis duration was ≤5 years in 83.3% patients. Hypertension (97.6%) and diabetes mellitus (76.8%) were the most common comorbidities. PCI procedures per 1,000 ESKD patients dropped from 6.2 in 2010 to 2.6 in 2018 (P<0.001) while the index hospitalization mortality increased from 0.9% to 3.0% (P<0.001). The 30-day and 1-year mortality also significantly increased from 3.2% to 6.1% and 26.5% to 31.9%, respectively. However, 1-year repeat revascularization rates dropped from 19.8% to 17.0% between 2010-2018 (P<0.001). A significant increase in comorbidity burden was also noted.

Conclusions: We demonstrate a consistent decrease in PCI rates for SIHD in ESKD patients. However, the in-hospital mortality has increased significantly, in part, due to an increasing high-risk profile of these patients. Our results call for individualized clinical decision-making when exploring revascularization options in ESRD patients with SIHD.