Clinical outcomes of drug-eluting stent era according to chronic kidney disease and diabetes (IRIS-DES registry)

Abstract

Abstract Aims Clinical outcomes in patients who underwent percutaneous coronary intervention (PCI) using various generation drug-eluting stent (DES) stratified by the degree of renal dysfunction and diabetes were not fully elucidated. Methods and results This study included 16,741 patients enrolled in the multicenter IRIS-DES registry. Renal insufficiency was graded according to the baseline renal function. The primary endpoint was major adverse cardiocerebrovascular event (MACCE), defined as a composite of all cause death, myocardial infarction, cerebrovascular events, and target vessel revascularization. Among 16,741 patients, 11,274 (67%) had eGFR ≥60 ml min–1 1.73m–2 at baseline, 4,280 (26%) had eGFR of ≥30 and <60, and 1187 (7%) had eGFR <30. At 3.6 years of follow-up (interquartile range, 2.97–4.87 yrs), the cumulative incidence of MACCE substantially increased according to the severity of renal insufficiency (11.3% in eGRF ≥60, 16.0% in eGFR of ≥30 and <60, and 29.7% in eGRF <30, respectively, P<0.001). After multivariable adjustment of clinical covariates, as compared with patients with eGFR ≥60, the hazard ratios for MACCE was significantly higher in patients with eGFR of ≥30 and <60 (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.1–1.4) and in patients with eGFR <30 (HR 2.0, 95% CI 1.7–2.4). This effect showed better consistent trends in non-diabetes and non- renal insufficiency in subgroup analysis of the primary endpoint (Figure 3). Conclusions Renal insufficiency is significantly associated with worse clinical outcomes in the DES era. Also, the effect on MACCE was consistent, being better in non-diabetes and non- renal insufficiency. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): CVRF