Differential Impact of Chronic Kidney Disease Stages on the Survival Benefit of Percutaneous Coronary Intervention: A Large Real-world Cohort Study.

IF 2.2 3区医学 Q2 PERIPHERAL VASCULAR DISEASE

Angiology Pub Date : 2025-03-04 DOI:10.1177/00033197251324629

Xiaozhao Lu, Jin Liu, Jingru Deng, Chenyang Wang, Yuqi Li, Jielan Wu, Ying Shi, Shiqun Chen, Ziyao Yuan, Ning Tan, Jiyan Chen, Yong Liu, Fei Gao

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Abstract

Chronic kidney disease (CKD) is prevalent among patients with coronary artery disease (CAD) and exacerbates myocardial ischemia. However, the survival benefit of percutaneous coronary intervention (PCI) across different stages of CKD remains controversial. CAD patients (n = 17,418) with CKD (mean age, 69.5 ± 9.9 years; 70.9% male) were included in the Cardiorenal Improvement II cohort from 2007 to 2020. Patients were grouped by PCI or medical treatment and further categorized by stages 3a-5 CKD. Multivariable Cox regression was performed to investigate the associations of cardiovascular- and all-cause mortality with PCI and CKD stage, and to compare predictors of outcomes in patients stratified by advanced CKD. During a median follow-up of 4.2 years, 4605 (26.4%) participants died. Compared with medical treatment, PCI was not associated with improved survival benefit among patients with stage 3b-5 CKD (all P > .05). Among patients with advanced CKD, hypertension, hyperfibrinogenemia and moderate-severe malnutrition were more significantly associated with increased cardiovascular mortality with relatively high attributable risk. PCI was not associated with a survival advantage among patients with advanced CKD. Hypertension, hyperfibrinogenemia and malnutrition may contribute to poor prognosis in patients with advanced kidney disease.

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慢性肾脏疾病分期对经皮冠状动脉介入治疗的生存获益的不同影响：一项大型真实世界队列研究

慢性肾脏疾病（CKD）在冠状动脉疾病（CAD）患者中普遍存在，并加剧心肌缺血。然而，经皮冠状动脉介入治疗（PCI）在不同阶段CKD的生存效益仍然存在争议。CAD合并CKD患者（n = 17,418）(平均年龄69.5±9.9岁；2007年至2020年，70.9%为男性)纳入心肾改善II队列。患者按PCI或药物治疗分组，并进一步按3a-5期CKD进行分类。多变量Cox回归研究了心血管和全因死亡率与PCI和CKD分期的关系，并比较了晚期CKD患者预后的预测因子。在中位随访4.2年期间，4605名（26.4%）参与者死亡。与药物治疗相比，PCI与3b-5期CKD患者的生存获益改善无关（P < 0.05）。在晚期CKD患者中，高血压、高纤维蛋白原血症和中重度营养不良与心血管死亡率增加的相关性更显著，归因风险相对较高。PCI与晚期CKD患者的生存优势无关。高血压、高纤维蛋白原血症和营养不良可能导致晚期肾病患者预后不良。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Angiology 医学-外周血管病

CiteScore

5.50

自引率

14.30%

发文量

180

审稿时长

6-12 weeks

期刊介绍： A presentation of original, peer-reviewed original articles, review and case reports relative to all phases of all vascular diseases, Angiology (ANG) offers more than a typical cardiology journal. With approximately 1000 pages per year covering diagnostic methods, therapeutic approaches, and clinical and laboratory research, ANG is among the most informative publications in the field of peripheral vascular and cardiovascular diseases. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 13 days