The impact of renal impairment on 30-day outcomes following percutaneous coronary intervention (PCI) for acute coronary syndromes.

Abstract

Background: The presence of chronic kidney disease (CKD) amongst patients presenting with acute coronary syndromes (ACS) has been associated with worse outcomes, including higher rates of mortality and bleeding. Methods: The primary objective was to analyse the impact the degree of baseline renal impairment on 30-day outcomes in patients undergoing PCI for ACS. This was a multicentre, retrospective cohort study between 2005 to 2018 from the Melbourne Interventional Group (MIG) registry. We compared the outcomes in patients with CKD (eGFR <60 mL/min/1.73m2) with those who had preserved renal function (eGFR ≥60 mL/min/1.73m2). CKD was classified into 2 groups: mild-moderate (eGFR 30-59 mL/min/1.73m2) and severe (eGFR<30 mL/min/1.73m2 including end stage renal failure on dialysis). Results: A total of 22,065 patients with complete data were included. The mean age in the advanced CKD, mild-moderate CKD and no-CKD groups were 70, 72 and 62 years (p<0.001), respectively. Length-of-hospital stay was longer in the advanced CKD group (5.0 vs. 3.0 days, p<0.001) compared with the no-CKD group. 30-day outcomes are presented in the figure below. Conclusion: Despite advances in PCI, there remains a stepwise incremental risk associated with diminishing baseline renal function as reflected by poorer short-term outcomes at 30 days.