Percutaneous Coronary Intervention In Patients With CKD:A Retrospective Study

ObjectiveThe clinical data and prognosis of patients with coronary heart disease complicated with renal insufficiency after PCI in our hospital from 2015 to 2020 were analyzed retrospectively,and the prognostic factors of these patients were explored.The long-term prognostic results of ticagrelor and clopidogrel were compared,and their efficacy and safety were analyzed to guide clinical diagnosis,treatment and management.MethodsPatients with coronary heart disease complicated with renal insufficiency who underwent PCI in North Guangdong people’s Hospital from 2015 to 2020 were investigated retrospectively.The baseline data and long-term prognosis of the patients were recorded with EXCEL table and RedCap system.The main end points included all-cause death,myocardial infarction and stroke,and the secondary end points included BARC bleeding classification,revascularization and hospitalization for heart failure and angina pectoris.SPSS26.0 and R software were used to analyze the data.ResultsCompared with clopidogrel group,the main endpoints of ticagrelor group(HR,0.79,95%CI,0.50-1.25,P=0.310),cardiovascular death(HR,0.75,95%CI,0.31-1.81,P=0.521),death of any cause(HR,0.83,95%CI,0.41-1.66,P=0.597),recurrent myocardial infarction(HR,0.64,95%CI,0.24-1.72,P=0.375)and stroke(HR,1.03;95%CI,0.38-2.91,P=0.772)was not statistically significant in the three extended multivariate COX models.However,the risk of BARC total bleeding was higher in the ticagrelor group(HR,1.88,95%CI,1.12-3.15,P=0.026).After adjusting for confounding factors,BARC total bleeding(HR,3.12,95%C,1.90～5.68,P=0.006),BARC 1 or 2(HR,3.36,95%CI,1.82～6.82,P=0.015)and BARC 3 or 5(HR,3.67,95%CI,1.15～7.21,P=0.041)were more statistically significant.The subgroup analysis did not find any significant interaction.Compared with the normal renal function group,the renal insufficiency group was older,with more complications of hypertension,diabetes,gout and stroke.The proportion of high grade of Killip and NYHA,blood lipid,D-dimer,uric acid,troponin,brain natriuretic peptide and in-hospital mortality were higher.The ratio of troponin T/Ck-MB increased gradually with the deterioration of renal function.Multivariate Logistic regression showed that the decrease of ejection fraction was an independent factor for poor prognosis.Conclusion1.Compared with clopidogrel,tegrel did not improve the main clinical endpoints(cardiovascular death,recurrent myocardial infarction,death of any cause or stroke)in patients with ACS complicated with renal insufficiency,but increased the risk of bleeding in these patients.2.The ratio of troponin/CK-MB increased significantly with the development of CKD,but had nothing to do with the long-term prognosis.3.The decrease of ejection fraction was independently related to the poor long-term prognosis of patients with renal insufficiency after PCI.