Cause-Specific Mortality in Patients With Advanced Chronic Kidney Disease in the ISCHEMIA-CKD Trial

Mandeep S Sidhu ,Sripal Bangalore,Gregg W Stone ,David J Maron ,Zhen Huang ,Francesco Orso ,Carlo Briguori ,Jerome L Fleg ,David Borrego ,Evgeny L Kretov ,Roy Mathew ,Jonathan Newman ,Patricia A Pellikka ,Evgeny Shutov ,Tomasz Mazurek ,Marek Roik ,Shaun G Goodman ,Judith S Hochman ,Karen P Alexander ,C.g Sajeev ,Bernard R Chaitman ,Sean M O’brien ,Radmila Lyubarova ,Stephen Balter ,Harmony R Reynolds ,O.l Bockeria ,Frank Rockhold

doi:10.1016/j.jcin.2022.10.062

Abstract

BackgroundIn ISCHEMIA-CKD, 777 patients with advanced chronic kidney disease and chronic coronary disease had similar all-cause mortality with either an initial invasive or conservative strategy (27.2% vs 27.8%, respectively). ObjectivesThis prespecified secondary analysis from ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease) was conducted to determine whether an initial invasive strategy compared with a conservative strategy decreased the incidence of cardiovascular (CV) vs non-CV causes of death. MethodsThree-year cumulative incidences were calculated for the adjudicated cause of death. Overall and cause-specific death by treatment strategy were analyzed using Cox models adjusted for baseline covariates. The association between cause of death, risk factors, and treatment strategy were identified. ResultsA total of 192 of the 777 participants died during follow-up, including 94 (12.1%) of a CV cause, 59 (7.6%) of a non-CV cause, and 39 (5.0%) of an undetermined cause. The 3-year cumulative rates of CV death were similar between the invasive and conservative strategies (14.6% vs 12.6%, respectively; HR: 1.13, 95% CI: 0.75-1.70). Non-CV death rates were also similar between the invasive and conservative arms (8.4% and 8.2%, respectively; HR: 1.25; 95% CI: 0.75-2.09). Sudden cardiac death (46.8% of CV deaths) and infection (54.2% of non-CV deaths) were the most common cause-specific deaths and did not vary by treatment strategy. ConclusionsIn ISCHEMIA-CKD, CV death was more common than non-CV or undetermined death during the 3-year follow-up. The randomized treatment assignment did not affect the cause-specific incidences of death in participants with advanced CKD and moderate or severe myocardial ischemia. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease [ISCHEMIA-CKD]; NCT01985360)

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