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Impact of chronic kidney disease on clinical outcomes in patients with unprotected left main coronary artery disease: insights from a large-sized all-comers registry

Session Poster Session 7

Speaker Assistant Professor Dae-Won Kim

Congress : ESC Congress 2019

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Coronary Intervention: Stents
  • Session type : Poster Session
  • FP Number : P6528

Authors : DW Kim (Daejon,KR), SH Her (Daejon,KR)

Authors:
DW Kim1 , SH Her1 , 1Daejon St. Mary's Hospital, Division of Cardiology - Daejon - Korea (Republic of) ,

On behalf: the IRIS-MAIN Registry Investigators

Citation:

Aims: Clinical outcomes according to the status of renal insufficiency were not fully evaluated in patients with significant left main coronary artery disease (LMCAD).

Methods and results: The current study analyzed 4894 patients with unprotected LMCAD enrolled in the multicenter IRIS-MAIN registry. Renal insufficiency was graded according to the baseline renal function (eGFR). The primary clinical outcome was major adverse cardiocerebrovascular event (MACCE), defined as a composite of death, myocardial infarction, stroke, and any revascularization. At baseline, 3824 (78%) had preserved renal function (eGFR =60 ml·min -1·1.73m-2), 838 (17%) had moderate renal dysfunction (eGFR of = 30 and <60), and 232 (5%) had severe renal dysfunction (eGFR <30). At 2 years, the rates of MACCE were significantly higher in patients with lower levels of eGRF (9.1% in eGRF =60, 16.0% in eGFR of = 30 and <60, and 36.2% in eGRF <30, respectively, P<0.001). After multivariable adjustment, as compared with patients with eGFR = 60, the hazard ratios (HR) for MACCE proportionally increased for patients with eGFR of = 30 and <60 (HR 1.46, 95% CI 1.18-1.79) and for those with eGFR <30 (HR 3.39, 95% CI 2.61-4.40). The adjusted risks for MACCE was similar between percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG) in patients with preserved and moderate renal dysfunction. However, in patients with severe renal dysfunction, PCI was associated with a significantly higher risk of MACCE compared to CABG (38.5% vs. 24.7%, HR 1.80, 95% CI 1.03-3.13, P=0.04).

Conclusions: The degree of renal insufficiency was proportionately associated with worse clinical outcomes in patients with LMCAD. In patients with severe renal dysfunction of eGFR of <30, PCI was associated with a higher risk of MACCE as compared with CABG.

2-Year Event Rate, n (%)

Crude Risk

Adjusted Risk*

Patient Groups

Revascularization type

HR

95% CI

P value

HR

95% CI

P value

PCI

CABG (reference)

All patients

306/2825 (10.8)

144/1453 (9.9)

1.160

0.952-1.414

0.141

1.265

1.036-1.546

0.021

Subgroups by

baseline eGFR

Preserved renal function

(eGFR >60)

190/2289 (8.3)

89/1098 (8.1)

1.080

0.840-1.389

0.549

1.125

0.874-1.449

0.360

Moderate renal dysfunction

(eGFR ≥ 30 and <60)

71/419 (169%)

37/282 (13.1%)

1.394

0.936-2.074

0.102

1.276

0.854-1.909

0.234

Severe renal dysfunction

(eGFR <30)

45/117 (38.5%)

18/73 (24.7%)

1.997

1.154-3.458

0.014

1.798

1.032-3.130

0.038

Crude and Adjusted Risk of Primary Composite Outcome After PCI and CABG, According to the Status of Baseline Renal Function.

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