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. 2021 Oct;36(10):1496-1505.
doi: 10.1007/s00380-021-01837-8. Epub 2021 Apr 7.

Prognostic ability of mid-term worsening renal function after percutaneous coronary intervention: findings from the SHINANO registry

Yoshiteru Okina  1 , Takashi Miura  2 , Keisuke Senda  3 , Minami Taki  4 , Masanori Kobayashi  5 , Masafumi Kanai  6 , Yukari Okuma  7 , Takashi Yanagisawa  8 , Naoto Hashizume  9 , Kyuhachi Otagiri  10 , Kyoko Shoin  11 , Noboru Watanabe  12 , Soichiro Ebisawa  3 , Kenichi Karube  13 , Hiroyuki Nakajima  14 , Tatsuya Saigusa  3 , Yusuke Miyashita  6 , Daisuke Kashiwagi  3 , Keisuke Machida  10 , Naoyuki Abe  6 , Takahiro Tachibana  8 , Yusuke Kanzaki  9 , Takuya Maruyama  9 , Hidetomo Nomi  8 , Takahiro Sakai  3 , Hisanori Yui  3 , Tomoaki Mochidome  2 , Takahiro Kobayashi  2 , Toshio Kasai  2 , Uichi Ikeda  2 , Koichiro Kuwahara  3
Affiliations

Prognostic ability of mid-term worsening renal function after percutaneous coronary intervention: findings from the SHINANO registry

Yoshiteru Okina et al. Heart Vessels. 2021 Oct.

Abstract

Chronic kidney disease is a prognostic factor for cardiovascular disease. Worsening renal function (WRF), specifically, is an important predictor of mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). We evaluate the prognostic impact of mid-term WRF after PCI on future cardiovascular events. We examined the renal function data of 1086 patients in the first year after PCI using the SHINANO 5-year registry. Patients were divided into two groups, mid-term WRF and non-mid-term WRF, and primary outcomes were major adverse cardiovascular events (MACE) and death. Mid-term WRF was defined as an increase in creatinine (≥ 0.3 mg/dL) in the first year after PCI. Mid-term WRF was found in 101 patients (9.3%), and compared to non-mid-term WRF, it significantly increased the incidence of MACE (p < 0.001), and all-cause death (p < 0.001), myocardial infarction (p = 0.001). Furthermore, mid-term WRF patients had higher incidence of future heart failure (p < 0.001) and new-onset atrial fibrillation (p = 0.01). Patients with both mid-term WRF and chronic kidney disease had increased MACE compared to patients with either condition alone (p < 0.001). Similarly, patients with mid-term WRF and acute kidney injury had increased MACE compared to patients with either condition alone (p < 0.001). Multivariate Cox regression analysis revealed mid-term WRF as a strong predictor of MACE (hazard ratio: 2.50, 95% confidence interval 1.57-3.98, p < 0.001). Mid-term WRF after PCI negatively affects MACE, as well as future admission due to heart failure and new-onset atrial fibrillation, chronic kidney disease, and acute kidney injury.

Keywords: Coronary vascular disease; Major adverse cardiovascular event (MACE); Prognostic factor; Renal insufficiency.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Patient selection flow chart. PCI percutaneous coronary intervention, MI myocardial infarction, WRF worsening renal function
Fig. 2
Fig. 2
Cumulative incidence for MACE rate according to mid-term WRF. The incidences of MACE were significantly higher in mid-term WRF patients compared to non-mid-term WRF patients. MACE includes all-cause death, non-fatal myocardial infarction, and stroke. MACE major adverse cardiac event, WRF worsening renal function
Fig. 3
Fig. 3
Cumulative incidence for any outcome according to WRF. a Death; b non-fatal myocardial infarction; c stroke; d new onset of atrial fibrillation; e heart failure; f new induction of hemodialysis. The incidences of death, non-fatal myocardial infarction, new-onset atrial fibrillation, future heart failure, and new induction of hemodialysis were significantly higher in WRF patients compared to non-WRF patients. WRF worsening renal failure, MI myocardial infarction
Fig. 4
Fig. 4
Cumulative incidence for MACE rate according to mid-term WRF and CKD. The incidence of MACE was significantly greater in CKD with mid-term WRF group compared to patients with only CKD, only mid-term WRF, and patients with neither CKD nor mid-term WRF. MACE major adverse cardiac event, WRF worsening renal function, CKD chronic kidney disease
Fig. 5
Fig. 5
Cumulative incidence for MACE rate according to mid-term WRF and AKI. The incidences of MACE in patients AKI with mid-term WRF was significantly higher compared to patients with only AKI, mid-term WRF only, patients with neither AKI nor mid-term WRF group. MACE major adverse cardiac event, WRF worsening renal function, AKI acute kidney injury
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