Abstract 13808: Impact of Complex Percutaneous Coronary Intervention Features Among Patients With or Without Chronic Kidney Disease

Abstract

Introduction: Among patients undergoing percutaneous coronary intervention (PCI), those with chronic kidney disease (CKD) sustain poor clinical outcomes. However, there is a paucity of data on the impact of complex PCI (CPCI) on long-term prognosis, according to the presence of CKD. Objective: To determine the prognostic impact of complex procedural features in patients undergoing PCI with and without CKD. Methods: Patients undergoing PCI at a tertiary-care center between 2012 and 2019 were stratified according to the presence of CKD and procedural complexity. A CPCI was defined by the presence of ≥1 of the following: stent length >60 mm, ≥3 stents, ≥3 lesions, ≥3 target vessels, bifurcation with ≥2 stents, or chronic total occlusion. The primary outcome of interest was major adverse cardiac events (MACE), a composite of death, myocardial infarction (MI) and target vessel revascularization (TVR) at 1 year. Results: Out of 15,071 patients, our study population consisted of 4,537 (30.1%) with CKD of whom 1,151 (25.4%) underwent CPCI, while 2,983 (28.3%) patients without CKD underwent a CPCI. The prevalence of traditional risk factors was similar among patients within the same group (CKD and no-CKD), irrespective of PCI complexity. Nonetheless, patients undergoing CPCI had more extensive coronary artery disease (i.e., higher syntax score, severe calcification, and longer lesion length). CPCI was associated with a higher risk of MACE at 1 year in both groups, though a greater risk was observed in those without concomitant CKD, mainly driven by a higher risk of MI and TVR (Figure 1). However, the risk of all-cause death was significantly higher among CKD patients undergoing a CPCI, and there was no significant difference between those with and without CPCI in non-CKD group. Conclusions: CPCI is associated with an increase in the risk of 1-year MACE among patients with or without CKD. The larger increase in the risk of MACE is observed in those without CKD, than those with CKD.