Coronary interventions

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

EuroIntervention 2023;19:493-501. DOI: 10.4244/EIJ-D-23-00086

Alessandro Spirito
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

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 (adj. HR 2.64, 95% CI: 1.95-3.56; interaction p-value <0.001). CKD and DM in combination were associated with an increased risk of all secondary outcomes, whereas alone, each condition was only associated with all-cause death and cardiac death.

Conclusions: Among women receiving DES, the combined presence of CKD and DM was associated with a higher risk of the composite of death or MI and of any secondary outcome, whereas alone, each condition was associated with an increase in all-cause and cardiac death.

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deathdiabetesdrug-eluting stentmiscellaneousrenal insufficiency
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