Abstract 2535: The Adverse Long-Term Impact of Renal Impairment on Patients undergoing Percutaneous Coronary Intervention in the DES Era

Abstract

Renal impairment (RI) is known to be associated with poor in-hospital outcomes following percutaneous coronary intervention (PCI) but its effect on outcomes beyond one year, particularly in the drug eluting stent (DES) era has not been reported. We undertook an observational study to determine the long-term impact of renal impairment on patients undergoing PCI at a large, tertiary cardiac referral centre. Baseline creatinine was available for 11,969 of the 15,012 consecutive patients undergoing PCI at our institution between April 2000 and Sept 2007. Patients were stratified into those with or without at least moderate RI, defined as a creatinine clearance <60ml/min (CKD class ≤ 3). In-hospital mortality and morbidity were calculated for each cohort. Follow up data was obtained through linkage to a provincial registry. Kaplan-Meier analysis was performed and Cox multiple regression analysis was used to identify independent predictors of late mortality and MACE (major adverse cardiovascular events), and to examine the association between DES use and late outcomes in the presence or absence of RI. Of the 11,953 patients with available long-term follow-up, 3070 had RI (25.7%). In hospital mortality and MACE were significantly increased in those patients (3.34% vs 0.44%, p<0.001, and 5.73% vs 2.2%, p<0.001, respectively). At 7 year follow-up, survival and MACE-free survival were both reduced (64.5 ± 1.4% vs 89.4 ± 0.5%, p<0.001, and 44.0 ± 1.4% vs 63.4 ± 0.8%, p<0.001). RI was identified as an independent predictor of both late mortality and cardiovascular events (HR 2.2, p<0.0001 and HR 1.4, p<0.0001) but DES use was associated with a significant risk reduction for these events (HR 0.7, p<0.0001). In patients with RI, DES use, rather than bare metal stents, was associated with a reduction in mortality (HR 0.83, CI 0.66 –1.0, p=0.1) and reduced subsequent CABG (HR 0.46, CI 0.22– 0.97, p=0.041) but had no effect on repeat PCI (p=0.63). In a large registry of “all-comers” for PCI, RI was an independent predictor of adverse late outcomes at 7 year follow-up. DES use however was associated with improved long-term outcomes in this high risk cohort.