Impact of chronic kidney disease on cardiovascular and renal events in patients undergoing percutaneous coronary intervention with everolimus-eluting stent: Risk stratification with C-reactive protein

Kazuhiro Dan, Toru Miyoshi, Makoto Nakahama, Tomofumi Mizuno, Kenzo Kagawa, Yoichiro Naito, Satoshi Kawada, Hiroshi Ito

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Chronic kidney disease (CKD) and inflammation play critical roles in atherosclerosis. There is limited evidence regarding the relationship between CKD and patients receiving second-generation drug-eluting stents for coronary artery disease. Objective: This study aimed to investigate the effect of CKD on cardiovascular and renal events in patients undergoing percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES). Methods: We analyzed 504 consecutive patients with stable angina pectoris and significant coronary artery stenosis treated with EES. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m 2 before coronary angiography. The primary outcome was the occurrence of major adverse renal and cardiovascular events (MARCE) including cardiac death, revascularization, heart failure, cerebral infarction, worsening renal function > 25% from baseline, and renal replacement therapy at 1 year. Results: Patients were divided into the a MARCE (n = 126) and a non-MARCE (n = 378) group. The incidence of CKD was 51% in all subjects (including those on hemodialysis) and was significantly higher in the MARCE group than in the non-MARCE group (p = 0.00001). Multivariate logistic regression analysis identified that CKD was independently associated with MARCE (adjusted odds ratio 2.03, 95% confidence interval 1.21-3.39, p = 0.007). Patients were divided into four groups based on CKD and C-reactive protein (CRP) level prior to initial coronary angiography. Cox proportional hazards analysis revealed that patients with CKD and high CRP (≥0.3 mg/dL) had the worst prognosis (hazard ratio 4.371, 95% confidence interval 2.634-7.252, p = 0.00001) compared to patients without CKD and with low CRP. Conclusion: CKD combined with CRP predicted more clinical events in patients undergoing PCI with EES.

Original languageEnglish
Pages (from-to)151-159
Number of pages9
JournalCardioRenal Medicine
Volume8
Issue number2
DOIs
Publication statusPublished - Apr 1 2018

Keywords

  • C-reactive protein
  • Cardiovascular and renal event
  • Chronic kidney disease
  • Everolimus-eluting stent
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Urology

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