NDT Advance Access originally published online on May 21, 2007
Nephrology Dialysis Transplantation 2007 22(9):2578-2585; doi:10.1093/ndt/gfm241
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Risk of target lesion revascularization after coronary stenting in patients with and without chronic kidney disease
1Renal Division, 2Section of Clinical Biometrics, Department of Medicine, Brigham and Women's Hospital, and 3Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
Correspondence and offprint requests to: David Charytan, MD, Brigham and Women's Hospital, Renal Division, Clinical Biometrics, 1 Brigham Circle, 3rd Floor, Boston, MA 02115, USA. Email: dcharytan{at}partners.org
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Abstract |
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Background. Rates of restenosis following percutaneous coronary intervention with stent placement are high in patients with advanced renal failure. Whether mild to moderate chronic kidney disease (CKD) is associated with a similarly increased need for short or long-term target lesion revascularization (TLR) following coronary stenting is uncertain.
Methods. We analysed results from 1228 patients enrolled in four separate, randomized, controlled clinical trials who underwent elective coronary angioplasty with stenting and were prospectively followed for 5 years after the index procedure. Cox proportional hazards regression was used to correct for confounding and to estimate the short and long-terms risks of target lesion revascularization in patients with vs without mild to moderate CKD.
Results. During a median follow-up of 5 years, 205 patients (16.7%) required TLR with 59 (4.8%) requiring TLR after the first year. Mild (HR 1.07, 95% CI 0.74–1.53) and moderate (HR 0.95, 95% CI 0.552–1.64) CKD were not associated with an increase in the adjusted, overall-risk of TLR. However, mild to moderate CKD was associated with a non-significantly increased risk of late TLR (HR 1.40, 95% CI 0.73–2.69).
Conclusions. Coronary stenting appears to be similarly effective in patients with mild to moderate CKD and patients with normal renal function. While target lesion revascularization is rarely needed beyond the first year after revascularization, long-term results of coronary stenting may be less-favourable in patients with CKD.
Keywords: angioplasty; chronic kidney disease; coronary artery disease; percutaneous coronary intervention; restensosis; revascularization
*The authors wish it to be known that, in their opinion, the first two authors contributed equally to this work.
Received for publication: 18. 9.06
Accepted in revised form: 29. 3.07