INTRODUCTION:
Advanced chronic kidney disease is described as stages 3-5 of the chronic kidney disease classification defined as a reduction in glomerular filtration rate of less than 60 ml/min (1). Chronic kidney disease (CKD) has been known as one of the prominent risk factors for coronary artery disease (2). Percutaneous coronary intervention (PCI) has become an acceptable alternative to open heart surgery in patients suffering from coronary artery disease (3). This procedure improves patient survival, appropriately controls angina symptoms, reduces the need for long-term hospitalization, and reduces treatment costs (4-5). However, similar to other invasive or even minimally invasive therapeutic interventions, this procedure should be performed in high-risk groups with some considerations and precautions. These patients may experience far different outcomes than low-risk patients who have PCI. In patients with chronic kidney disorders, the need to use contrast material, scheduling consecutive dialysis sessions, the risk of microembolization, and requiring arterial wall instrumentation may lead to poorer outcomes of the PCI procedure, and the clinical benefits of PCI may be lower in such patients (6). In the last decade, various trials have evaluated the outcomes of the procedure in patients with CKD, which were basically associated with contradictory results. In a large, randomized trial (ISCHEMIA-CKD) on 777 CKD patients who underwent PCI procedure or medical therapy, 3.2-year outcomes including death, cardiac ischemic attack, or re-hospitalization were shown to be similar in both groups (7). In several trials, the presence of underlying chronic kidney disease was considered a major risk factor for long-term poorer outcomes following PCI, such as higher mortality and progression of renal impairment (8-9), also the impaired renal elimination of antithrombotic drugs exposes these patients to a higher likelihood of bleeding complications (10-11). During our literature review on databases, we found a small number of studies looking into the impacts of PCI on ACKD patients, Limpijankit and his colleague as one of the few studies in this matter determined one-year survival of PCI among 207 CKD patients stage 4-5 without dialysis and 5 with dialysis was 65.2%, 68.0% and 69.4 respectively (12).   Therefore, the outcome of PCI procedures in patients with ACKD still remains uncertain. In the present study, we investigated the clinical outcomes of PCI in cases with Advanced chronic kidney disease and compared the in-patient mortality rate of PCI between ACKD and non-ACKD candidates.