Prognostic Impact of Renal Dysfunction at 1-Year Follow-Up on Clinical Outcomes After Percutaneous Coronary Intervention

• Published in: Journal of Atherosclerosis and Thrombosis Vol. 30; no. 7; pp. 786 - 794
• Main Authors: Takahashi, Tetsuya, Watanabe, Tetsu, Aono, Tomonori, Otaki, Yoichiro, Wanezaki, Masahiro, Nishiyama, Satoshi, Kutsuzawa, Daisuke, Kato, Shigehiko, Tamura, Harutoshi, Arimoto, Takanori, Takahashi, Hiroki, Watanabe, Masafumi
• Format: Journal Article
• Language: English
• Published: Japan Japan Atherosclerosis Society 01-07-2023
• Subjects: Clinical outcome; Coronary Artery Disease - complications; Follow-Up Studies; Humans; Original; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Prognosis; Renal dysfunction; Renal Insufficiency - complications; Retrospective Studies; Risk Factors; Treatment Outcome; Clinical outcome; Percutaneous coronary intervention; Renal dysfunction
• ISSN: 1340-3478; 1880-3873
• DOI: 10.5551/jat.63746

Aims: Renal dysfunction is an independent predictor of adverse outcomes in patients with coronary artery disease (CAD). However, the prognostic impact of mid-term changes in renal dysfunction status remains unclear. This study aimed to investigate the impact of mid-term changes in renal dysfunction status on long-term clinical outcomes in CAD patients who underwent percutaneous coronary intervention (PCI).Methods: We enrolled 382 consecutive patients with CAD who underwent PCI. Renal dysfunction was defined as a reduced estimated glomerular filtration rate (eGFR) of ＜60 mL/min/1.73m2. Renal dysfunction status was evaluated at baseline and 1-year follow-up after PCI. We divided the study population into three groups: persistent renal dysfunction, new-onset renal dysfunction, and no or improved renal dysfunction at 1-year follow-up as compared with on baseline. The endpoints of this study were composite events, including all-cause death, acute coronary syndrome, target vessel revascularization, and stroke.Results: At baseline, renal dysfunction was observed in 77 patients (20%). At the 1-year follow-up, new-onset renal dysfunction was observed in 46 patients (12%), and 59 patients (15%) had persistent renal dysfunction. Kaplan-Meier analysis revealed a significantly higher event rate in patients with persistent renal dysfunction and new-onset renal dysfunction (log-rank test, P=0.0003). In the multivariate Cox proportional hazards analysis, persistent renal dysfunction and new-onset renal dysfunction were independently associated with composite events after adjusting for confounding factors (adjusted hazard ratios 4.08 and 2.64, 95% confidence intervals 1.72-9.57 and 1.03-6.31, P=0.0016, P=0.0045, respectively).Conclusion: Persistent and new-onset renal dysfunction at 1-year follow-up were associated with unfavorable outcomes in patients with CAD who underwent PCI.