Impact of chronic kidney disease on clinical outcomes in diabetic patients undergoing percutaneous coronary intervention in the era of newer-generation drug-eluting stents

Su Min Kim, Dipti Ranjan Tripathy, Sang Wook Park, Bonil Park, Jung Woo Son, Junwon Lee, Youngjin Youn, Sung Gyun Ahn, Minsoo Ahn, Jang Young Kim, Byungsu Yoo, Seunghwan Lee, Junghan Yoon

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and Objectives: Chronic kidney disease (CKD) is known to be a major adverse predictor in diabetes mellitus (DM) patients undergoing percutaneous coronary intervention (PCI). It is expected that the use of newer-generation drug-eluting stents (DES) would improve clinical outcomes in these patients. We evaluated the impact of CKD on clinical outcomes in diabetic patients undergoing PCI using newer-generation DES in a real-world setting. Subjects and Methods: A total of 887 patients who underwent PCI with newer-generation DES and who had a history of DM or HbA1c >6.5% at the time of hospitalization were analyzed. These patients were divided into groups without CKD (n=549) and with CKD (n=338). Among survivors at discharge, a patient-oriented composite outcome (POCO) including all-cause mortality, myocardial infarction (MI), and revascularization was evaluated, together with a device-oriented composite outcome (DOCO) including cardiac death, target vessel-related MI, and target lesion revascularization at a follow-up period of one year. Results: The incidence of POCO (5.4% vs. 14.0%, log-rank p<0.001) and DOCO (1.1% vs. 4.1%, log-rank p<0.001) was higher in patients with CKD. According to multivariate analysis, which was adjusted for baseline differences in demographic, clinical, and angiographic factors, the presence of CKD was an independent predictor of POCO (hazard ratio [HR]: 1.82, 95% confidence interval [CI]: 1.07 to 3.12), but not of DOCO (HR 2.08, 95% CI: 0.69-6.28). Conclusion: In DM patients, CKD is an independent and powerful predictor of patient-related outcomes, but not of device-related outcomes in the era of newer-generation DES.

Original languageEnglish
Pages (from-to)222-230
Number of pages9
JournalKorean Circulation Journal
Volume47
Issue number2
DOIs
Publication statusPublished - 2017 Mar 1

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Drug-Eluting Stents
Percutaneous Coronary Intervention
Chronic Renal Insufficiency
Equipment and Supplies
Diabetes Mellitus
Myocardial Infarction
Confidence Intervals
Myocardial Revascularization
Patient Discharge
Survivors
Hospitalization
Multivariate Analysis
Demography

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{dbafd792d7d348a086e92ef615fd2e5d,
title = "Impact of chronic kidney disease on clinical outcomes in diabetic patients undergoing percutaneous coronary intervention in the era of newer-generation drug-eluting stents",
abstract = "Background and Objectives: Chronic kidney disease (CKD) is known to be a major adverse predictor in diabetes mellitus (DM) patients undergoing percutaneous coronary intervention (PCI). It is expected that the use of newer-generation drug-eluting stents (DES) would improve clinical outcomes in these patients. We evaluated the impact of CKD on clinical outcomes in diabetic patients undergoing PCI using newer-generation DES in a real-world setting. Subjects and Methods: A total of 887 patients who underwent PCI with newer-generation DES and who had a history of DM or HbA1c >6.5{\%} at the time of hospitalization were analyzed. These patients were divided into groups without CKD (n=549) and with CKD (n=338). Among survivors at discharge, a patient-oriented composite outcome (POCO) including all-cause mortality, myocardial infarction (MI), and revascularization was evaluated, together with a device-oriented composite outcome (DOCO) including cardiac death, target vessel-related MI, and target lesion revascularization at a follow-up period of one year. Results: The incidence of POCO (5.4{\%} vs. 14.0{\%}, log-rank p<0.001) and DOCO (1.1{\%} vs. 4.1{\%}, log-rank p<0.001) was higher in patients with CKD. According to multivariate analysis, which was adjusted for baseline differences in demographic, clinical, and angiographic factors, the presence of CKD was an independent predictor of POCO (hazard ratio [HR]: 1.82, 95{\%} confidence interval [CI]: 1.07 to 3.12), but not of DOCO (HR 2.08, 95{\%} CI: 0.69-6.28). Conclusion: In DM patients, CKD is an independent and powerful predictor of patient-related outcomes, but not of device-related outcomes in the era of newer-generation DES.",
author = "Kim, {Su Min} and Tripathy, {Dipti Ranjan} and Park, {Sang Wook} and Bonil Park and Son, {Jung Woo} and Junwon Lee and Youngjin Youn and Ahn, {Sung Gyun} and Minsoo Ahn and Kim, {Jang Young} and Byungsu Yoo and Seunghwan Lee and Junghan Yoon",
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Impact of chronic kidney disease on clinical outcomes in diabetic patients undergoing percutaneous coronary intervention in the era of newer-generation drug-eluting stents. / Kim, Su Min; Tripathy, Dipti Ranjan; Park, Sang Wook; Park, Bonil; Son, Jung Woo; Lee, Junwon; Youn, Youngjin; Ahn, Sung Gyun; Ahn, Minsoo; Kim, Jang Young; Yoo, Byungsu; Lee, Seunghwan; Yoon, Junghan.

In: Korean Circulation Journal, Vol. 47, No. 2, 01.03.2017, p. 222-230.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of chronic kidney disease on clinical outcomes in diabetic patients undergoing percutaneous coronary intervention in the era of newer-generation drug-eluting stents

AU - Kim, Su Min

AU - Tripathy, Dipti Ranjan

AU - Park, Sang Wook

AU - Park, Bonil

AU - Son, Jung Woo

AU - Lee, Junwon

AU - Youn, Youngjin

AU - Ahn, Sung Gyun

AU - Ahn, Minsoo

AU - Kim, Jang Young

AU - Yoo, Byungsu

AU - Lee, Seunghwan

AU - Yoon, Junghan

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background and Objectives: Chronic kidney disease (CKD) is known to be a major adverse predictor in diabetes mellitus (DM) patients undergoing percutaneous coronary intervention (PCI). It is expected that the use of newer-generation drug-eluting stents (DES) would improve clinical outcomes in these patients. We evaluated the impact of CKD on clinical outcomes in diabetic patients undergoing PCI using newer-generation DES in a real-world setting. Subjects and Methods: A total of 887 patients who underwent PCI with newer-generation DES and who had a history of DM or HbA1c >6.5% at the time of hospitalization were analyzed. These patients were divided into groups without CKD (n=549) and with CKD (n=338). Among survivors at discharge, a patient-oriented composite outcome (POCO) including all-cause mortality, myocardial infarction (MI), and revascularization was evaluated, together with a device-oriented composite outcome (DOCO) including cardiac death, target vessel-related MI, and target lesion revascularization at a follow-up period of one year. Results: The incidence of POCO (5.4% vs. 14.0%, log-rank p<0.001) and DOCO (1.1% vs. 4.1%, log-rank p<0.001) was higher in patients with CKD. According to multivariate analysis, which was adjusted for baseline differences in demographic, clinical, and angiographic factors, the presence of CKD was an independent predictor of POCO (hazard ratio [HR]: 1.82, 95% confidence interval [CI]: 1.07 to 3.12), but not of DOCO (HR 2.08, 95% CI: 0.69-6.28). Conclusion: In DM patients, CKD is an independent and powerful predictor of patient-related outcomes, but not of device-related outcomes in the era of newer-generation DES.

AB - Background and Objectives: Chronic kidney disease (CKD) is known to be a major adverse predictor in diabetes mellitus (DM) patients undergoing percutaneous coronary intervention (PCI). It is expected that the use of newer-generation drug-eluting stents (DES) would improve clinical outcomes in these patients. We evaluated the impact of CKD on clinical outcomes in diabetic patients undergoing PCI using newer-generation DES in a real-world setting. Subjects and Methods: A total of 887 patients who underwent PCI with newer-generation DES and who had a history of DM or HbA1c >6.5% at the time of hospitalization were analyzed. These patients were divided into groups without CKD (n=549) and with CKD (n=338). Among survivors at discharge, a patient-oriented composite outcome (POCO) including all-cause mortality, myocardial infarction (MI), and revascularization was evaluated, together with a device-oriented composite outcome (DOCO) including cardiac death, target vessel-related MI, and target lesion revascularization at a follow-up period of one year. Results: The incidence of POCO (5.4% vs. 14.0%, log-rank p<0.001) and DOCO (1.1% vs. 4.1%, log-rank p<0.001) was higher in patients with CKD. According to multivariate analysis, which was adjusted for baseline differences in demographic, clinical, and angiographic factors, the presence of CKD was an independent predictor of POCO (hazard ratio [HR]: 1.82, 95% confidence interval [CI]: 1.07 to 3.12), but not of DOCO (HR 2.08, 95% CI: 0.69-6.28). Conclusion: In DM patients, CKD is an independent and powerful predictor of patient-related outcomes, but not of device-related outcomes in the era of newer-generation DES.

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