Effect of Chronic Kidney Disease in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents A Patient-Level Pooled Analysis of Randomized Controlled Trials

被引：33

作者：

Baber, Usman ^{[1
]}

Giustino, Gennaro ^{[1
]}

Sartori, Samantha ^{[1
]}

Aquino, Melissa ^{[1
]}

Stefanini, Giulio G. ^{[2
]}

Steg, P. Gabriel ^{[3
]}

Windecker, Stephan ^{[4
]}

Leon, Martin B. ^{[5
]}

Wijns, William ^{[6
]}

Serruys, Patrick W. ^{[7
]}

Valgimigli, Marco ^{[8
]}

Stone, Gregg W. ^{[5
]}

Dangas, George D. ^{[1
]}

Morice, Marie-Claude ^{[9
]}

Camenzind, Edoardo ^{[10
]}

Weisz, Giora ^{[7
]}

Smits, Pieter C. ^{[11
]}

Kandzari, David ^{[12
]}

Von Birgelen, Clemens ^{[13
]}

Mastoris, Ioannis ^{[1
]}

Galatius, Soren ^{[14
]}

Jeger, Raban V. ^{[15
]}

Kimura, Takeshi ^{[16
]}

Mikhail, Ghada W. ^{[17
]}

Itchhaporia, Dipti ^{[18
]}

Mehta, Laxmi ^{[19
]}

Ortega, Rebecca ^{[20
]}

Kim, Hyo-Soo ^{[21
]}

Kastrati, Adnan ^{[22
]}

Chieffo, Alaide ^{[23
]}

Mehran, Roxana ^{[1
]}

机构：

[1] Icahn Sch Med Mt Sinai, Zena & Michael Wiener Cardiovasc Inst, New York, NY 10029 USA

[2] Humanitas Res Hosp, Div Clin & Intervent Cardiol, Milan, Italy

[3] Univ Paris Diderot, AP HP, Inflammat & REmodelage, Dept Hosp Univ Fibrose,INSERM U693, Paris, France

[4] Univ Hosp Bern, Dept Cardiol, CH-3010 Bern, Switzerland

[5] Columbia Univ, Med Ctr, Div Cardiol, New York, NY USA

[6] Onze Lieve Vrouwziekenhuis Ziekenhuis, Cardiovasc Ctr Aalst, Aalst, Belgium

[7] Thoraxctr Erasmus MC, Rotterdam, Netherlands

[8] Univ Ferrara, Dept Cardiol, I-44100 Ferrara, Italy

[9] Inst Cardiovasc Paris Sud, Dept Cardiol & Cardiovasc Surg, Paris, France

[10] Univ Hosp Nancy Brabois, ILCV, Vandoeuvre Les Nancy, France

[11] Maasstad Hosp, Dept Cardiol, Rotterdam, Netherlands

[12] Piedmont Heart Inst, Atlanta, GA USA

[13] Thoraxcentrum Twente, Enschede, Netherlands

[14] Bispebjerg Hosp, Dept Cardiol, Copenhagen, Denmark

[15] Univ Basel Hosp, Dept Cardiol, CH-4031 Basel, Switzerland

[16] Kyoto Univ, Grad Sch Med, Dept Cardiol, Kyoto, Japan

[17] Imperial Coll Healthcare NHS Trust, Dept Cardiol, London, England

[18] Hoag Mem Hosp, Dept Cardiol, Newport Beach, CA USA

[19] Ohio State Univ, Med Ctr, Dept Cardiol, Columbus, OH 43210 USA

[20] Soc Cardiovasc Angiog & Intervent, Washington, DC USA

[21] Seoul Natl Univ Main Hosp, Dept Cardiol, Seoul, South Korea

[22] Herzzentrum, Munich, Germany

[23] Ist Sci San Raffaele, Intervent Cardiol, I-20132 Milan, Italy

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2016年 / 9卷 / 01期

关键词：

chronic kidney disease; drug-eluting stents; outcomes; women; NON-INFERIORITY TRIAL; BARE-METAL STENTS; ARTERY-DISEASE; DOUBLE-BLIND; BIODEGRADABLE POLYMER; 1-YEAR OUTCOMES; DURABLE POLYMER; SLOW-RELEASE; LESIONS; REVASCULARIZATION;

D O I：

10.1016/j.jcin.2015.09.023

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES This study sought to evaluate: 1) the effect of impaired renal function on long-term clinical outcomes in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES); and 2) the safety and efficacy of new-generation compared with early-generation DES in women with chronic kidney disease (CKD). BACKGROUND The prevalence and effect of CKD in women undergoing PCI with DES is unclear. METHODS We pooled patient-level data for women enrolled in 26 randomized trials. The study population was categorized by creatinine clearance (CrCl) <45 ml/min, 45 to 59 ml/min, and >= 60 ml/min. The primary endpoint was the 3-year rate of major adverse cardiovascular events (MACE). Participants for whom baseline creatinine was missing were excluded from the analysis. RESULTS Of 4,217 women included in the pooled cohort treated with DES and for whom serum creatinine was available, 603 (14%) had a CrCl <45 ml/min, 811 (19%) had a CrCl 45 to 59 ml/min, and 2,803 (66%) had a CrCl >= 60 ml/min. A significant stepwise gradient in risk for MACE was observed with worsening renal function (26.6% vs. 15.8% vs. 12.9%; p < 0.01). Following multivariable adjustment, CrCl <45 ml/min was independently associated with a higher risk of MACE (adjusted hazard ratio: 1.56; 95% confidence interval: 1.23 to 1.98) and all-cause mortality (adjusted hazard ratio: 2.67; 95% confidence interval: 1.85 to 3.85). Compared with older-generation DES, the use of newer-generation DES was associated with a reduction in the risk of cardiac death, myocardial infarction, or stent thrombosis in women with CKD. The effect of new-generation DES on outcomes was uniform, between women with or without CKD, without evidence of interaction. CONCLUSIONS Among women undergoing PCI with DES, CKD is a common comorbidity associated with a strong and independent risk for MACE that is durable over 3 years. The benefits of newer-generation DES are uniform in women with or without CKD. (J Am Coll Cardiol Intv 2016;9:28-38) (C) 2016 by the American College of Cardiology Foundation.

引用

页码：28 / 38

页数：11

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