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Clinical outcomes after percutaneous coronary intervention in non-dialysis patients with acute coronary syndrome and advanced renal dysfunction

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Abstract

Background

Data about the clinical outcomes of ACS patients with advanced renal dysfunction (estimated glomerular filtration rate < 30 mL/min/1.73 m2) following percutaneous coronary intervention (PCI) are limited.

Methods

We examined the data obtained from 194 ACS patients with non-dialysis advanced renal dysfunction who underwent PCI at five hospitals. The primary composite endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, and ischemic stroke).

Results

Eighty patients (41.2%) were diagnosed with ST-elevation myocardial infarction (STEMI), and 117 patients (58.8%) with non-ST-elevation ACS (NSTE-ACS). Overall patients were followed for a median of 657.5 days. Cumulative incidence of MACCE at median follow-up was 32.3% (45.4% for STEMI and 23.4% for NSTE-ACS). Kaplan–Meier analysis demonstrated that patients in the STEMI group had significantly higher incidence of MACCE than those in the non-STEMI and unstable angina group (Log-rank p < 0.001). In-hospital MACCE rate was higher in the STEMI group than in the NSTE-ACS group, whereas post-discharge MACCE rate was comparable between the two groups. In the multivariate analysis, STEMI and Killip classification ≥ 2 were associated with in-hospital MACCE. On the other hand, body mass index and serum albumin at admission were independent predictors of post-discharge MACCE.

Conclusions

Short- and long-term prognoses following PCI in non-dialysis patients with ACS and advanced renal dysfunction is still unfavorable. STEMI and Killip classification ≥ 2 were independent predictors for in-hospital MACCE, and body mass index and serum albumin were for post-discharge MACCE.

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Authors and Affiliations

  1. Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo, 446-8602, Japan

    Yusuke Uemura, Shinji Ishikawa, Kenji Takemoto & Masato Watarai

  2. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yosuke Negishi, Akihito Tanaka, Hideki Ishii & Toyoaki Murohara

  3. Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan

    Kensuke Takagi, Naoyuki Yoshioka & Itsuro Morishima

  4. Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan

    Norio Umemoto & Naoki Shibata

  5. Department of Cardiology, Tosei General Hospital, Seto, Japan

    Yosuke Inoue & Hiroshi Asano

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Corresponding author

Correspondence to Yusuke Uemura.

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Conflict of interest

H.I. received lecture fees from Astellas Pharma Inc., Astrazeneca Inc., Daiichi-Sankyo Pharma Inc., and MSD K. K. T.M. received lecture fees from Bayel Pharmaceutical Co., Ltd., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K. K., Pfizer Japan Inc., Sanofi-aventis K. K., and Takeda Pharmaceutical Co., Ltd. T.M. received unrestricted research grant for Department of Cardiology, Nagoya University Graduate School of Medicine from Astellas Pharma Inc., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K. K., Otsuka Pharma Ltd., Pfizer Japan Inc., Sanofi-aventis K. K., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd.

Human and animal rights

This study was performed in accordance with the Declaration of Helsinki, and the research protocol was approved by the ethics committees of research institute (Approval no. 2017–0275). Because of a retrospective cohort study, informed consent from individual patients was waived.

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Supplementary Fig. 1. Study population

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Uemura, Y., Ishikawa, S., Takemoto, K. et al. Clinical outcomes after percutaneous coronary intervention in non-dialysis patients with acute coronary syndrome and advanced renal dysfunction. Clin Exp Nephrol 24, 339–348 (2020). https://doi.org/10.1007/s10157-019-01839-x

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  • DOI: https://doi.org/10.1007/s10157-019-01839-x

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