Abstract 19884: Contemporary Risk of Follow-up Adverse Events in Older Patients with Chronic Kidney Disease and Dialysis Undergoing Percutaneous Coronary Interventions: A Report from the Merged NCDR CMS Registry
Background: While mild chronic kidney disease (CKD) is associated with poor outcomes in patients undergoing percutaneous coronary intervention (PCI), less is known about the clinical outcomes of older patients with moderate and severe CKD or patients on chronic dialysis.
Methods: 295,542 patients ≥65 years old underwent PCI at 793 sites participating in the Cath-PCI registry with linked Medicare inpatient claims data for follow-up between January 1, 2004-December 31, 2007. Patients were stratified by estimated glomerular filtration rate (GFR) into 5 groups: Normal renal function (GFR ≥60 ml/min/1.73 m2), mild CKD (GFR 45-59 ml/min/1.73 m2), moderate CKD (GFR 30-44 ml/min/1.73 m2), severe CKD (GFR<30 ml/min/1.73 m2) and chronic dialysis. Multivariable Cox proportional hazards analyses were performed to determine the association of CKD severity and follow-up severe bleeding, myocardial infarction (MI) and death.
Results: Overall, 34,330 (11.6%) patients had moderate CKD, 8,509 (2.9%) had severe CKD and 5,182 (1.8%) were dialysis dependent. Worsening renal function was associated with substantially worse 30 month outcomes including major bleeding (3.0% vs 3.7% vs 4.9% vs 6.3% vs 9.6%, p<0.001), myocardial infarction (5.6% vs 6.6% vs 9.1% vs 13.7% vs 19.5%, p<0.001) and death (10.6% vs 13.8% vs 22.1% vs 32.7% vs 51.9%, p<0.001), which persisted after multivariable adjustment (Table). Patients on dialysis represented the highest risk group overall.
Conclusion: In a contemporary registry of older PCI patients, approximately 1 in 6 have moderate to severe CKD or are on chronic dialysis. These patients have the highest rates of follow-up major bleeding, MI and death. This data highlights the risks associated with PCI in older patients with CKD and the urgency to clarify the potential benefits of PCI over medical therapy in this high risk cohort.
- © 2010 by American Heart Association, Inc.