Prognostic Value of Incomplete Revascularization after Percutaneous Coronary Intervention Following Acute Coronary Syndrome: Focus on CKD Patients.

Thomas Cardi,Marion Kibler,Sébastien Hess,Patrick Ohlmann,Benjamin Marchandot,Anas Kayali,Olivier Morel,Antonin Trimaille,Jessica Ristorto,Viet Anh Hoang,Laurence Jesel

doi:10.3390/jcm8060810

Abstract

Background: Residual coronary artery disease (CAD) has been associated with worsened prognosis in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). The residual SYNTAX Score (rSS) aims to assess residual CAD after PCI. The association between kidney function and rSS has not been investigated in ACS patients. In this study, we sought to determine whether chronic kidney disease (CKD) patients exhibit more incomplete revascularization following stage revascularization procedures by PCI. We evaluated the impact of incomplete revascularization on the occurrence of major cardiovascular events (MACE) at one-year follow-up. Methods: A total of 831 ACS patients undergoing PCI were divided into 3 subgroups according to their estimated Glomerular Filtration Rate (eGFR): 695 with eGFR ≥ 60 mL/min/1.73 m², 108 with eGFR 60–30 mL/min/1.73 m², 28 with eGFR < 30 mL/min/1.73 m². Initial SYNTAX score (SS) and rSS were calculated for all patients. Incomplete revascularization was defined by rSS > 8. The primary endpoint was the occurrence of MACE (all-cause mortality, myocardial infarction (MI), repeated revascularization except from planned revascularization, stroke and definite or probable recurrent stent thrombosis) one year after the index procedure. Results: Severe CKD patients had significantly higher MACE (12.0% vs. 25.9% vs. 35.7%; p < 0.001), all-cause mortality, cardiovascular mortality and heart failure events. Patients with rSS > 8 had higher MACE, all-cause and cardiovascular mortality. CKD was an independent predictive factor of rSS > 8 (HR: 1.65, 95% CI: 1.01 to 2.71; p = 0.048). Multivariate analysis identified rSS > 8, but not CKD, as an independent predictor of cardiac death and MACE. Conclusion: In ACS, CKD is predictive of incomplete revascularization, which stands out as a strong predictor of adverse cardiovascular outcomes including cardiac death and MACE.

Highlights

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As previously published by several groups including ours, the extent of P2Y12 inhibition as assessed by platelet reactivity index (PRI) vasodilator stimulated phosphoprotein (VASP) was inversely related to renal function [8]
The main finding of this study is that chronic kidney disease (CKD) is predictive of incomplete revascularization during acute coronary syndromes (ACS) as assessed by higher residual SYNTAX Score (rSS) values

Summary

Introduction

WWiitthh rreessppeecctt ttoo tthhee iimmppoorrttaannccee ooff nnoonn--ccuullpprriitt lleessiioonnss iinn aaccuuttee ccoorroonnaarryy ssyynnddrroommeess ((AACCSS)),, tthhee ccuurrrreennttcchhaararactcetreirziaztaitoinonoforfesriedsuidaul atlhaetrhoesrcolesrcoletircobtiucrdbeunrdbeynthbeygtehneergicenderniocmdiennaotimonin“amtiounlti“pmleuvletsipselel dviessesaesled”isaepapsea”raspinpseuarffis ciniesnutfftiociaecnctutroataeclcyuarasstelsys athsseersisskthoefraisdkveorfsaedcvaerrdsieocvaarsdciuolvaarsocuutlcaormouetsc[o1m–3e]s. We sought to determine whether chronic kidney disease (CKD) patients exhibit more incomplete revascularization following stage revascularization procedures by PCI. We evaluated the impact of incomplete revascularization on the occurrence of major cardiovascular events (MACE) at one-year follow-up. Results: Severe CKD patients had significantly higher MACE (12.0% vs 25.9% vs 35.7%; p < 0.001), all-cause mortality, cardiovascular mortality and heart failure events. Patients with rSS > 8 had higher MACE, all-cause and cardiovascular mortality. Multivariate analysis identified rSS > 8, but not CKD, as an independent predictor of cardiac death and MACE. Conclusion: In ACS, CKD is predictive of incomplete revascularization, which stands out as a strong predictor of adverse cardiovascular outcomes including cardiac death and MACE

Results

Discussion

Conclusion