RESULTS
In this study, among 1826536 patients who were candidates for PCI from
2005 to 2011, 113018 patients (6.2%) suffered from ACKD, based on the
criteria for diagnosis of chronic kidney disease. Patients with kidney
disease mostly were older and had histories of diabetics, peripheral
artery disease, cerebrovascular accidents, and atrial fibrillation as
compared to the patients without renal insufficiency (Table 1). The
evaluation of the trend of the changes in procedural mortality during
the evaluated years (from 2005 to 2011) in two groups of patients with
and without advanced chronic kidney disease indicated higher
age-adjusted inpatient mortality rate in the group with ACKD in each
year studied compared to those without this co-morbidity. However, over
the years mortality in ACKD patients undergoing PCI improved over the
years study while it was stable with a mild increase in non-CKD
patients. (Figure 1) For the
first year studied in 2006, age age-adjusted mortality rate for patients
undergoing PCI was 149 per 100,000 vs 48 per 100,000 in patients without
ACKD (p<0001). For the last year studied in 2011, age-adjusted
mortality was 124.1 per 100,000 in ACKD patients vs 40.4 per 100,000 in
patients with no ACKD, (P <0.0001).
Using the multivariable logistic regression modeling adjusting for
baseline parameters and cardiovascular risk factors such as diabetes
mellitus, hypertension, hyperlipidemia, peripheral artery disease,
atrial fibrillation, cerebrovascular disease, myocardial infarction,
and tobacco use, ACKD remained independently associated with higher
mortality (OR 1.32, CI 1.27-1.36, P<0.001) (OR = 1.32, P
< 0.001) following PCI. Furthermore, an increasing trend of
PCI performed in ACKD patients was noted over the years studied (Figure
2).