Impact of polyvascular disease and chronic kidney disease on long-term cardiovascular outcomes after sirolimus-eluting stent implantation

Abstract

Background: Polyvascular disease (PolyVD) and chronic kidney disease (CKD) have been known to be independent risk factors for cardiovascular events. We evaluated the association between PolyVD and CKD through long-term cardiovascular outcomes after sirolimus-eluting stent (SES) implantation in patients with each stage of CKD. Methods: A total of 1797 patients with CKD except hemodialysis patients who had undergone SES implantation from November 2002 to January 2007 and 6-year follow up were enrolled in this study. Estimated glomerular filtration rate (eGFR) was classified into three stages: mild (eGFR 60-89), moderate (eGFR 30-59), and severe (eGFR < 30) CKD. The 1797 patients were divided into two groups: those with PolyVD (276) and those without PolyVD (1521). The number of patients with each stage (with PolyVD vs. without PolyVD) was as follows: mild 94 (34%) vs. 780 (51%), moderate 155 (56%) vs. 635 (42%), and severe 27 (10%) vs. 106 (7%). Results: The patients with PolyVD were older and had more cardiovascular risk factors. In the patients with moderate and severe CKD, the patients with PolyVD had a higher incidence of major adverse cardiovascular events (MACE: cardiovascular death, myocardial infarction, and target lesion revascularization) (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.06-1.91, p=0.019) than those without PolyVD. Kaplan–Meier estimates for MACE stratified according to the CKD severity are shown in the figure. In the only patients with PolyVD, those with both moderate (HR 1.92, 95% CI 1.08-2.98) and severe CKD (HR 4.13, 95% CI 1.93-8.85) had higher incidence rates of MACE, as compared with those with mild CKD. ![Figure][1] Kaplan-Meier estimates of MACE Conclusion: The impact of CKD on the long-term cardiovascular outcomes after SES implantation was different between patients with and without PolyVD. [1]: pending:yes