Alessandro Spirito; Dipti Itchhaporia; Samantha Sartori; Edoardo Camenzind; Alaide Chieffo; George Dangas; Soren Galatius; Raban  V. Jeger; David Kandzari; Adnan Kastrati; Hyo-Soo Kim; Takeshi Kimura; Martin  B. Leon; Laxmi  S. Mehta; Ghada Mikhail; Marie-Claude Morice; Johny Nicolas; Brunna Pileggi; Patrick  W. Serruys; Pieter  C. Smits; P.  Gabriel Steg; Gregg  W. Stone; Marco Valgimigli; Birgit Vogel; Clemens von Birgelen; Giora Weisz; William Wijns; Stephan Windecker; Roxana Mehran

doi:10.4244/EIJ-D-23-00086

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

The reference multimedia journal in interventional cardiology

Clinical research

DOI: 10.4244/EIJ-D-23-00086

Impact of chronic kidney disease and diabetes on clinical outcomes in women undergoing PCI

Alessandro Spirito¹, MD; Dipti Itchhaporia², MD; Samantha Sartori¹, PhD; Edoardo Camenzind³, MD; Alaide Chieffo⁴, MD; George D. Dangas¹, MD, PhD; Soren Galatius⁵, MD; Raban V. Jeger⁶, MD; David E. Kandzari⁷, MD; Adnan Kastrati⁸, MD; Hyo-Soo Kim⁹^,¹⁰^,¹¹, MD; Takeshi Kimura¹², MD; Martin B. Leon¹³, MD; Laxmi S. Mehta¹⁴, MD; Ghada W. Mikhail¹⁵, MD; Marie-Claude Morice¹⁶, MD; Johny Nicolas¹, MD, MSc; Brunna Pileggi¹^,¹⁷, MD; Patrick W. Serruys¹⁸, MD, PhD; Pieter C. Smits¹⁹, MD; P. Gabriel Steg²⁰, MD, PhD; Gregg W. Stone¹, MD; Marco Valgimigli²¹^,²², MD, PhD; Birgit Vogel¹, MD; Clemens von Birgelen²³^,²⁴, MD, PhD; Giora Weisz²⁵, MD; William Wijns²⁶, MD; Stephan Windecker²⁷, MD; Roxana Mehran¹, MD

1. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2. Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA; 3. Institut Lorrain du Coeur et des Vaisseaux (ILCV), Centre Hospitalier Régional Universitaire Nancy-Brabois, Vandoeuvre-lès-Nancy, France; 4. Division of Cardiology, San Raffaele Hospital, Milan, Italy; 5. Bispebjerg University Hospital, Copenhagen, Denmark; 6. Triemli Hospital, Zurich, Switzerland; 7. Piedmont Heart Institute, Atlanta, GA, USA; 8. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; 9. Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; 10. Strategic Center of Cell & Bio Therapy, Seoul National University Hospital, Seoul, Republic of Korea; 11. Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine and College of Pharmacy, Seoul National University, Seoul, Republic of Korea; 12. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; 13. Department of Medicine, Columbia University Medical Center, New York, NY, USA; 14. Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; 15. Imperial College Healthcare NHS Trust, London, UK; 16. Department of Cardiology, Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France; 17. Department of Cardiopneumonology, Heart Institute of the University of São Paulo, São Paulo, Brazil; 18. University of Galway, Galway, Ireland; 19. Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands; 20. Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, Paris, France; 21. Istituto Cardiocentro Ticino, Lugano, Switzerland; 22. Università della Svizzera italiana (USI), Lugano, Switzerland; 23. Department of Health Technology and Services Research, Technical Medical Centre, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, the Netherlands; 24. Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands; 25. Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA; 26. University of Galway, Saolta University Healthcare Group, Galway, Ireland; 27. Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland; 27. Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland

Abstract

Background: For women undergoing drug-eluting stent (DES) implantation, the individual and combined impact of chronic kidney disease (CKD) and diabetes mellitus (DM) on outcomes is uncertain.

Aims: We sought to assess the impact of CKD and DM on prognosis in women after DES implantation.

Methods: We pooled patient-level data on women from 26 randomised controlled trials comparing stent types. Women receiving DES were stratified into 4 groups based on CKD (defined as creatine clearance <60 mL/min) and DM status. The primary outcome at 3 years after percutaneous coronary intervention was the composite of all-cause death or myocardial infarction (MI); secondary outcomes included cardiac death, stent thrombosis and target lesion revascularisation.

Results: Among 4,269 women, 1,822 (42.7%) had no CKD/DM, 978 (22.9%) had CKD alone, 981 (23.0%) had DM alone, and 488 (11.4%) had both conditions. The risk of all-cause death or MI was not increased in women with CKD alone (adjusted hazard ratio [adj. HR] 1.19, 95% confidence interval [CI]: 0.88-1.61) nor DM alone (adj. HR 1.27, 95% CI: 0.94-1.70), but was significantly higher in women with both conditions...

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