Open AccessImpact of Chronic Kidney Disease on Cardiovascular and Renal Events in Patients Undergoing Percutaneous Coronary Intervention with Everolimus-Eluting Stent: Risk Stratification with C-Reactive Protein
Author(s) -
Kazuhiro Dan,
Toru Miyoshi,
Makoto Nakahama,
Tomofumi Mizuno,
Kenzo Kagawa,
Yoshiro Naito,
Satoshi Kawada,
Hiroshi Ito
Publication year - 2018
Publication title -
cardiorenal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.661
H-Index - 21
eISSN - 1664-3828
pISSN - 1664-5502
DOI - 10.1159/000486971
Subject(s) - medicine , cardiology , percutaneous coronary intervention , kidney disease , renal function , hemodialysis , coronary artery disease , hazard ratio , odds ratio , myocardial infarction , unstable angina , confidence interval
Background: Chronic kidney disease (CKD) and inflammation play critical roles in atherosclerosis. There is limited evidence regarding the relationship between CKD and patients receiving second-generation drug-eluting stents for coronary artery disease. Objective: This study aimed to investigate the effect of CKD on cardiovascular and renal events in patients undergoing percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES). Methods: We analyzed 504 consecutive patients with stable angina pectoris and significant coronary artery stenosis treated with EES. CKD was defined as an estimated glomerular filtration rate 25% from baseline, and renal replacement therapy at 1 year. Results: Patients were divided into the a MARCE (n = 126) and a non-MARCE (n = 378) group. The incidence of CKD was 51% in all subjects (including those on hemodialysis) and was significantly higher in the MARCE group than in the non-MARCE group (p = 0.00001). Multivariate logistic regression analysis identified that CKD was independently associated with MARCE (adjusted odds ratio 2.03, 95% confidence interval 1.21–3.39, p = 0.007). Patients were divided into four groups based on CKD and C-reactive protein (CRP) level prior to initial coronary angiography. Cox proportional hazards analysis revealed that patients with CKD and high CRP (≥0.3 mg/dL) had the worst prognosis (hazard ratio 4.371, 95% confidence interval 2.634–7.252, p = 0.00001) compared to patients without CKD and with low CRP. Conclusion: CKD combined with CRP predicted more clinical events in patients undergoing PCI with EES.