0474: The deleterious cardiovascular impact of renal failure varies according to PCI indication

Abstract

To compare cardiovascular (CV) outcomes after contemporary PCI in patients with vs. without renal failure (RF) according to clinical presentation (ST-elevated myocardial infarction (STEMI), acute coronary syndrome (ACS), and stable coronary artery disease (sCAD)). Consecutive patients undergoing PCI with stent implantation were prospectively included from 2007 to 2012. RF was defined by a CrCl <60 ml/min. The primary end-point was all cause-mortality. The secondary endpoints were MACCE (cardiovascular death, myocardial infarction, stroke, TLR), TLR (target lesion revascularization), and ARC definite/probable stent thrombosis (ST) at one year. Among 5337 patients eligible, 1219 (23%) had PCI for STEMI, 1837 (34%) for ACS and 2281 (43%) for sCAD. There were 1441 (27%) patients with RF. At one year, patients with RF had increased all-cause mortality rates whatever the indication for PCI (Figure), with a 6 fold higher unadjusted all-cause mortality rate in STEMI patients (41% vs. 7.5%) and a 3 fold increase in ACS (19% vs. 6%) and sCAD (10% vs. 3%) patients compared to noRF patients (p< 0.0001 for all comparisons). MACCE were also higher in RF patients in each PCI indication (45% vs. 15% in STEMI, 23% vs. 14% in ACS, and 14% vs. 9% in sCAD, p<0.05 for all). STEMI-noRF patients had comparable mortality (p=0.209) and MACCE rates (p=0.658) than sCAD-RF patients. TLR ranged from 5.5% to 7.4%, and definite/probable ST was <2.5% without any difference in each PCI indication (p>0.05 for both). After multivariable analyses, RF was independently associated with an excess of death with a more than doubled relative risk in STEMI compared to ACS and sCAD patients (OR 5.3: CI 3.627-7.821 in STEMI vs. 2.1: CI 1.465-3.140 and 2.3: CI: 1.507-3.469 in ACS and sCAD, respectively, p<0.0001). RF is a stronger independent predictor of death after PCI in patients with STEMI compared to patients with ACS and sCAD. CV prognosis of sCAD-RF patients was found to be comparable to that of STEMI-noRF patients.