Abstract 17591: Impact of Renal Dysfunction on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention Who Have Concomitant Atrial Fibrillation: From the CREDO-Kyoto Registry Cohort-2
Background: Clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with atrial fibrillation (AF) and chronic kidney disease (CKD) have not yet been fully elucidated.
Methods and Results: Among 12716 patients undergoing PCI in the CREDO-Kyoto Registry Cohort-2, 1057 (8.3%) had AF. The AF patients were divided into 3 groups according to estimated glomerular filtration rate (eGFR); non-CKD (eGFR>=60, n=491), mild-CKD (eGFR=30-60, n=448), and severe-CKD (eGFR<30 or on hemodialysis, n=107) groups. Compared with non-CKD patients, mild- and severe-CKD patients were older (70.1±9.2, 74.8±8.7, and 74.2±9.5, P<0.001). Prevalence of oral anticoagulation (OAC) with warfarin at hospital discharge was 48%, 49%, and 44%, respectively (P=NS). Median follow-up duration was 5.1 years. AF was independently associated with stroke (adjusted hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.65-2.43). The 5-year risk of stroke in AF patients with non-, mild-, and severe-CKD was 8.9%, 13.7%, and 31.1%, respectively (P=0.01 for non- vs. mild-CKD and P<0.001 for non- vs. severe-CKD) (Figure A). The 5-year risk of major bleeding was 12.2%, 15.6%, and 51.3%, respectively (P=0.20 and P<0.001). Time in therapeutic range in AF patients receiving OAC was only 52.6% even when the therapeutic INR range was set at 1.6-2.6. CKD and CHADS2 score had an independent and additive impact on long-term stroke outcome (Figure B). The adjusted HR of stroke was 1.51 (0.99-2.34) for mild-CKD, 3.02 (1.64-5.48) for severe-CKD, and 3.42 (1.70-7.30) for CHADS2 score >=2.
Conclusions: Among AF patients undergoing PCI, CKD was associated with significantly higher risk of stroke. Considering the underuse and suboptimal intensity of OAC, more intensive antithrombotic therapy should be considered in AF patients undergoing PCI, especially for those with CKD. However, extremely high risk of major bleeding poses a dilemma in the antithrombotic therapy for severe-CKD patients.
- © 2013 by American Heart Association, Inc.