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Cardiovascular and renal outcomes following percutaneous coronary intervention in a population with renal disease: a case-control study

Allen, Lowri A, Pyart, Rhodri D, Holmes, Jennifer, Donovan, Kieron L, Anderson, Richard A and Phillips, Aled O 2019. Cardiovascular and renal outcomes following percutaneous coronary intervention in a population with renal disease: a case-control study. QJM: An International Journal of Medicine 112 (9) , pp. 669-674. 10.1093/qjmed/hcz130
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Abstract

Background Patients with renal disease are less likely to undergo percutaneous coronary intervention (PCI) due to concerns about poor outcomes. Aim We describe outcomes following PCI in individuals with chronic kidney disease (CKD), as compared with matched controls with comparable CKD who did not undergo PCI. We also identified factors predictive of poor outcomes following PCI amongst patients with CKD. Design Retrospective observational case-control study. Methods Cases were individuals with CKD (stages 1–5) undergoing PCI between 2008 and 2014. Controls were age, gender and creatinine-matched individuals not requiring PCI. We compared mortality between groups using Kaplan–Meier curves and Cox regression modelling. We assessed changes in serum creatinine using Wilcoxon Rank testing. We explored the relationship between biochemical and haematological measures (baseline creatinine, calcium, phosphate, calcium-phosphate product, parathyroid hormone, white cell count, haemoglobin, platelet count, c-reactive protein and total cholesterol) and post-PCI mortality, using logistic regression. Results We identified 144 cases and 144 controls. Mortality was significantly lower amongst cases compared with controls [hazard ratio 0.46 (95% confidence intervals 0.31, 0.69)]. PCI did not result in a significant change in renal function (P=0.52). Amongst cases, serum creatinine and calcium-phosphate product were predictors of mortality following PCI. Conclusion Cases undergoing PCI had lower mortality, and PCI was not associated with accelerated CKD progression. On this data, PCI should not be deferred as a treatment option in patients with CKD. Serum creatinine and calcium-phosphate product predict mortality following PCI in this cohort, and may be useful in risk-stratifying patients with CKD being considered for PCI.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Oxford University Press
ISSN: 1460-2725
Date of First Compliant Deposit: 14 June 2019
Date of Acceptance: 5 May 2019
Last Modified: 06 Sep 2019 13:25
URI: http://orca-mwe.cf.ac.uk/id/eprint/123437

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