Patients With CKD Receiving High-Risk PCI Have Increased Risk for MACCE

Patients with chronic kidney disease (CKD) on dialysis who receive high-risk percutaneous coronary intervention (PCI) are at a higher risk for the occurrence of 90-day major adverse cardiac and cerebrovascular events (MACCE) compared with individuals with normal kidney function, according to research presented at the Transcatheter Cardiovascular Therapeutics (TCT) Scientific Symposium 2022 held from September 17th through 19th, in Boston, Massachusetts.

Recognizing that scant data are available on clinical outcomes among patients who receive high-risk PCI using the heart pump Impella^® [Abiomed], investigators sought to analyze patients from the PROTECT III Study who received Impella-supported high-risk PCI. The study participants were stratified into 3 groups, according to kidney function. These groups were normal kidney function, CKD without dialysis, and CKD with dialysis. The researchers compared the composite incidence of MACCE, defined as all-cause death, myocardial infarction (MI), stroke/transient ischemic attack, and repeat revascularization, at 30 days and 90 days.

A total of 1223 patients were included in the study. On average patients were aged 71±11 years and 73% of the patients were men. Overall, 68% of the participants had normal kidney function (serum creatinine, 1.1 mg/dL [IQR, 0.9-1.2 mg/dL]), 23% had had CKD without dialysis (serum creatinine, 1.7 mg/dL [IQR, 1.3-1.9 mg/dL), and 9% were receiving dialysis.

The patients on dialysis were younger and had more comorbidities, including diabetes, heart failure, anemia, prior stroke, and peripheral vascular disease, than those not receiving dialysis. High-risk PCI status (urgent vs elective), proportion of patients experiencing acute MI, and mean SYNTAX scores were similar in the 3 groups of participants.

No significant differences in MACCE were demonstrated among the groups at 30 days and 90 days. Per Cox proportional hazards analysis, participants with normal renal function had comparable risks for 30-day and 90-day MACCE compared with patients with CKD not receiving dialysis. Further, patients with normal renal function had a significantly lower risk for 90-day MACCE compared with patients with CKD who were receiving dialysis (P =.03). Of note, participants receiving and those not receiving dialysis had a similar 90-day risk for MACCE. Further, patients with CKD who were not receiving dialysis had a higher risk for MI at 90 days.

“Patients with CKD and dialysis undergoing HRPCI [high-risk PCI] exhibit higher risk for 90-day MACCE compared to patients with normal kidney function,” the study authors wrote. “CKD patients without dialysis also had higher risk of MI at 90 days. Further research is needed.”