Cardiovascular outcomes following percutaneous coronary intervention with drug-eluting balloons in chronic kidney disease: a retrospective analysis

Michael Jonas,Gal Sella,Dan Haberman,Maayan Kagan,Gil Chernin

doi:10.1186/s12882-020-02089-w

Michael Jonas, Gal Sella + Show 3 more

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https://doi.org/10.1186/s12882-020-02089-w

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Journal: BMC Nephrology	Publication Date: Oct 23, 2020
Citations: 3	License type: open-access

Affiliation: Kaplan Medical Center

Abstract

BackgroundChronic kidney disease (CKD) is associated with poorer outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents. Drug-eluting balloons are used for in-stent restenosis and selected cases of de-novo coronary lesions. Little is known regarding the outcomes of individuals with CKD who undergo PCI with drug-eluting balloons. The goal of this study was to assess outcomes of PCI with drug-eluting balloons in individuals with CKD.MethodsIn a retrospective analysis, outcomes of PCI with drug-eluting balloons were compared between 101 patients with CKD and 261 without CKD. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73m2. We compared demographics, procedure data and clinical outcomes in the first and second years following the procedure.ResultsRates of major adverse cardiac events (MACE) and myocardial infarction were higher in patients with than without CKD: 23.8% vs. 13.8%, P < 0.005 and 15.9% vs. 3.8%, P < 0.001, respectively. Rates of target lesion revascularization were similar, 14.9 and 11.5%, respectively, P = 0.4. Shorter duration of dual anti-platelet therapy was observed among patients with than without CKD (10.0 + 3.4 vs. 10.9 + 3.7 months, P < 0.05). First-year hemorrhage episodes were similar in the two groups (0.08 ± 0.4 and 0.03 ± 0.2, respectively, P = 0.2). In a multivariate regression analysis, CKD was associated with increased risks of first year MACE (OR 2.1; 95% confidence interval 1.0-4.3, P < 0.001).ConclusionsPCI with drug-eluting balloons was associated with increased cardiovascular morbidity and mortality in patients with than without CKD. However, rates of target lesion revascularization were similar in the two groups. Shorter duration of dual anti-platelet therapy was observed in the CKD group.

Highlights

Chronic kidney disease (CKD) is associated with poorer outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents
For each patient who met the eligibility criteria we reviewed baseline characteristics including age, gender, body mass index and ejection fraction measured in the year before the PCI
In a multivariate regression model, CKD was associated with increased risks of first year major adverse cardiac events (MACE) and myocardial infarction (MI) (Table 4)

Summary

Introduction

Chronic kidney disease (CKD) is associated with poorer outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents. Drug-eluting balloons are used for in-stent restenosis and selected cases of de-novo coronary lesions. Little is known regarding the outcomes of individuals with CKD who undergo PCI with drug-eluting balloons. The goal of this study was to assess outcomes of PCI with drug-eluting balloons in individuals with CKD. Percutaneous coronary intervention (PCI) with drugeluting balloons (DEB) was established as an effective treatment for patients with ischemic heart disease (IHD) and in-stent restenosis (ISR) [1, 2]. A shorter period of DAPT could be beneficial for patients with bleeding diathesis, such as patients with chronic kidney disease (CKD) [2, 6].

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