Long-Term Outcomes of Percutaneous Coronary Intervention (PCI) in Octogenarians with Chronic Kidney Disease

Abstract

Background: Few studies have examined the long-term outcomes of percutaneous coronary intervention (PCI) in octogenarians (>80 years old) with chronic kidney disease (CKD). The aim of this study was to evaluate the long-term outcomes of octogenarians with CKD (eGFR < 60mL/min/1.73m2) undergoing PCI in our hospital. Methods: Retrospective data was collected for 319 consecutive patients who underwent PCI during January 2003 to December 2009. Patients were stratified on the presence of CKD (n=143) or no CKD (n=176) as defined by estimated GFR using the MDRD equation and followed for a mean of 33 months. The CKD group had higher rates of diabetes mellitus (40.4% versus 23.4%, p= <0.05), hypertension (98.6% versus 93.8%, p= <0.05), and peripheral vascular disease (19.6% versus 8.5%, p= <0.05). Other characteristics were similar among the groups. The primary outcome of the study was to compare the in-stent restenosis in octogenarians with and without CKD. All cause mortality and bleeding events post stenting were also compared.Results: A total of 59 patients developed in-stent restenosis: 16.6 % (n=29) in non CKD [17.3% with BMS (Bare metal Stents) and 14.3 % with DES (Drug Eluting Stents)] and 21 % (n=30) in the CKD group (22.8% with BMS and 16.7 % with DES) (P=0.31). There was no association of stent type and all cause death in either group; all cause death was significantly higher in the CKD patients. There was no significant difference in bleeding complications in CKD compared with non CKD groups (11.4% versus 10.5%, p= 0.85). However, CKD patients on aspirin and clopidogrel had a significantly higher incidence of bleeding (60% versus 40%, p=<0.001). Conclusion: As previously shown, CKD patients have a higher mortality than those without kidney disease. Long-term outcomes of BMS are comparable to DES in octogenarians with CKD. BMS may be preferable in CKD patients in order to avoid prolonged dual anti-platelet therapy with its attendant higher risk of bleeding in this group.