Impact of chronic kidney disease on long-term outcomes for coronary in-stent restenosis after drug-coated balloon angioplasty

  • Hsin-Fu Lee
    Affiliations
    Division of Cardiology, Department of Internal Medicine, New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan

    The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

    College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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  • Yu-Wen Cheng
    Affiliations
    The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

    College of Medicine, Chang Gung University, Taoyuan, Taiwan
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  • Jian-Rong Peng
    Affiliations
    Division of Cardiology, Department of Internal Medicine, New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan

    The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

    College of Medicine, Chang Gung University, Taoyuan, Taiwan
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  • Chiu-Yi Hsu
    Affiliations
    Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
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  • Chia-Hung Yang
    Affiliations
    Division of Cardiology, Department of Internal Medicine, New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan

    The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

    College of Medicine, Chang Gung University, Taoyuan, Taiwan
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  • Yi-Hsin Chan
    Correspondence
    Corresponding author at: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan, Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan.
    Affiliations
    The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

    College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
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  • Pao-Hsien Chu
    Correspondence
    Co-Corresponding author at:
    Affiliations
    The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

    College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Published:August 25, 2021DOI:https://doi.org/10.1016/j.jjcc.2021.08.010

      Highlights

      • The outcomes of patients with chronic kidney disease (CKD) and coronary instent restenosis after drug-coated balloon (DCB) angioplasty remain unclear.
      • Patients with CKD after DCB angioplasty had a significantly higher risk of adverse cardiac events.
      • The majority of adverse cardiac events were driven by severe CKD or end-stage renal disease (ESRD) patients.
      • Different revascularization strategies may be considered for severe CKD or ESRD patients.

      Abstract

      Background

      Patients with chronic kidney disease (CKD) and coronary instent restenosis (ISR) treated with drug-coated balloon (DCB) angioplasty have been excluded from randomized controlled trials. We aimed to investigate the clinical impact of CKD stratified by severity, on clinical outcomes for patients with ISR treated with DCB angioplasty.

      Methods

      This cohort study enrolled 1,376 patients treated with DCB angioplasty; 639 CKD patients defined as having an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and 737 patients with preserved renal function were identified. Risks of target vessel failure (TVF), all-cause mortality, and any repeated revascularization were analyzed.

      Results

      The CKD group had a significantly higher risk of TVF [adjusted hazard ratio (HR): 1.337; 95% confidence interval (CI): 1.125-1.590; p = 0.0010], all-cause mortality (adjusted HR: 2.553; 95% CI: 1.494-4.361; p = 0.0006), and any repeated revascularization (adjusted HR: 1.447; 95% CI: 1.087-1.927; p = 0.0114) compared with the non-CKD group. After multivariable adjustment, patients with severe CKD (eGFR = 15–29 mL/min/1.73 m2) and end-stage renal disease (ESRD) (eGFR <15 mL/min/1.73 m2) had a significantly higher risk of adverse events comparable to that in patients with preserved renal function.

      Conclusions

      In this cohort study, patients with CKD and ISR undergoing DCB angioplasty had a significantly higher risk of adverse events compared with patients with preserved renal function, whereas subgroups with mild to moderate CKD did not display this difference. Different revascularization strategies may be considered for patients with severe CKD or ESRD with ISR.

      Graphical abstract

      Keywords

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      References

        • Cai Q.
        • Mukku V.K.
        • Ahmad M.
        Coronary artery disease in patients with chronic kidney disease: a clinical update.
        Curr Cardiol Rev. 2013; 9: 331-339
        • Chan W.
        • Ivanov J.
        • Kotowycz M.A.
        • Sibbald M.
        • McGeoch R.
        • Crooks N.
        • et al.
        Association between drug-eluting stent type and clinical outcomes in patients with chronic kidney disease undergoing percutaneous coronary intervention.
        Can J Cardiol. 2014; 30: 1170-1176
        • Aoyama Y.
        • Hirayama H.
        • Ishii H.
        • Kobayashi K.
        • Ishikawa K.
        • Takigawa M.
        • et al.
        Impact of chronic kidney disease on a re-percutaneous coronary intervention for sirolimus-eluting stent restenosis.
        Coron Artery Dis. 2012; 23: 528-532
        • Peng J.R.
        • Chang C.J.
        • Wang C.L.
        • Tung Y.C.
        • Lee H.F.
        Impact of chronic kidney disease on long-term outcome in coronary bypass candidates treated with percutaneous coronary intervention.
        Korean Circ J. 2017; 47: 50-55
        • Kim S.M.
        • Tripathy D.R.
        • Park S.W.
        • Park B.
        • Son J.W.
        • Lee J.W.
        • et al.
        Impact of chronic kidney disease on clinical outcomes in diabetic patients undergoing percutaneous coronary intervention in the era of newer-generation drug-eluting stents.
        Korean Circ J. 2017; 47: 222-230
        • Her A.Y.
        • Shin E.S.
        Current management of in-stent restenosis.
        Korean Circ J. 2018; 48: 337-349
        • Scheller B.
        • Hehrlein C.
        • Bocksch W.
        • Rutsch W.
        • Haghi D.
        • Dietz U.
        • et al.
        Treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter.
        N Engl J Med. 2006; 355: 2113-2124
        • Unverdorben M.
        • Vallbracht C.
        • Cremers B.
        • Heuer H.
        • Hengstenberg C.
        • Maikowski C.
        • et al.
        Paclitaxel-coated balloon catheter versus paclitaxel-coated stent for the treatment of coronary in-stent restenosis.
        Circulation. 2009; 119: 2986-2994
        • Alfonso F.
        • Perez-Vizcayno M.J.
        • Cardenas A.
        • Garcia Del Blanco B.
        • Seidelberger B.
        • Iniguez A.
        • et al.
        A randomized comparison of drug-eluting balloon versus everolimus-eluting stent in patients with bare-metal stent-in-stent restenosis: the RIBS V Clinical Trial (Restenosis Intra-stent of Bare Metal Stents: paclitaxel-eluting balloon vs. everolimus-eluting stent).
        J Am Coll Cardiol. 2014; 63: 1378-1386
        • Habara S.
        • Mitsudo K.
        • Kadota K.
        • Goto T.
        • Fujii S.
        • Yamamoto H.
        • et al.
        Effectiveness of paclitaxel-eluting balloon catheter in patients with sirolimus-eluting stent restenosis.
        JACC Cardiovasc Interv. 2011; 4: 149-154
        • Tsai M.S.
        • Lin M.H.
        • Lee C.P.
        • Yang Y.H.
        • Chen W.C.
        • Chang G.H.
        • et al.
        Chang Gung Research Database: a multi-institutional database consisting of original medical records.
        Biomed J. 2017; 40: 263-269
        • Levey A.S.
        • Coresh J.
        • Greene T.
        • Stevens L.A.
        • Zhang Y.L.
        • Hendriksen S.
        • et al.
        Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate.
        Ann Intern Med. 2006; 145: 247-254
        • Cannon C.P.
        • Battler A.
        • Brindis R.G.
        • Cox J.L.
        • Ellis S.G.
        • Every N.R.
        • et al.
        American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes. A report of the American College of Cardiology Task Force on Clinical Data Standards (Acute Coronary Syndromes Writing Committee).
        J Am Coll Cardiol. 2001; 38: 2114-2130
        • Maldonado G.
        • Greenland S.
        Simulation study of confounder-selection strategies.
        Am J Epidemiol. 1993; 138: 923-936
        • Greenland S.
        Modeling and variable selection in epidemiologic analysis.
        Am J Public Health. 1989; 79: 340-349
        • Alfonso F.
        • Rivero F.
        Coronary revascularization in diabetic patients with chronic kidney disease.
        Eur Heart J. 2016; 37: 3448-3451
        • Bangalore S.
        • Guo Y.
        • Samadashvili Z.
        • Blecker S.
        • Xu J.
        • Hannan E.L.
        Revascularization in patients with multivessel coronary artery disease and chronic kidney disease: everolimus-eluting stents versus coronary artery bypass graft surgery.
        J Am Coll Cardiol. 2015; 66: 1209-1220
        • Kato K.
        • Yonetsu T.
        • Jia H.
        • Abtahian F.
        • Vergallo R.
        • Hu S.
        • et al.
        Nonculprit coronary plaque characteristics of chronic kidney disease.
        Circ Cardiovasc Imaging. 2013; 6: 448-456
        • Madhavan M.V.
        • Tarigopula M.
        • Mintz G.S.
        • Maehara A.
        • Stone G.W.
        • Genereux P.
        Coronary artery calcification: pathogenesis and prognostic implications.
        J Am Coll Cardiol. 2014; 63: 1703-1714
        • Kashiyama K.
        • Sonoda S.
        • Muraoka Y.
        • Suzuki Y.
        • Kamezaki F.
        • Tsuda Y.
        • et al.
        Coronary plaque progression of non-culprit lesions after culprit percutaneous coronary intervention in patients with moderate to advanced chronic kidney disease: intravascular ultrasound and integrated backscatter intravascular ultrasound study.
        Int J Cardiovasc Imaging. 2015; 31: 935-945
        • Kaneko H.
        • Yajima J.
        • Oikawa Y.
        • Matsuno S.
        • Funada R.
        • Tanaka S.
        • et al.
        Role of arterial stiffness and impaired renal function in the progression of new coronary lesions after percutaneous coronary intervention.
        Cardiovasc Interv Ther. 2013; 28: 56-62
        • Tonelli M.
        • Wiebe N.
        • Culleton B.
        • House A.
        • Rabbat C.
        • Fok M.
        • et al.
        Chronic kidney disease and mortality risk: a systematic review.
        J Am Soc Nephrol. 2006; 17: 2034-2047
        • Lee T.C.
        • Goodman S.G.
        • Yan R.T.
        • Grondin F.R.
        • Welsh R.C.
        • Rose B.
        • et al.
        Disparities in management patterns and outcomes of patients with non-ST-elevation acute coronary syndrome with and without a history of cerebrovascular disease.
        Am J Cardiol. 2010; 105: 1083-1089
        • Park K.W.
        • Lee J.M.
        • Kang S.H.
        • Ahn H.S.
        • Kang H.J.
        • Koo B.K.
        • et al.
        Everolimus-eluting Xience v/Promus versus zotarolimus-eluting resolute stents in patients with diabetes mellitus.
        JACC Cardiovasc Interv. 2014; 7: 471-481
        • Sardi G.L.
        • Maluenda G.
        • Torguson R.
        • Xue Z.
        • Suddath W.O.
        • Kent K.M.
        • et al.
        Impact of diabetes mellitus on long-term clinical outcomes of patients on chronic hemodialysis after percutaneous coronary intervention.
        J Interv Cardiol. 2012; 25: 147-155
        • Song C.
        • Sukul D.
        • Seth M.
        • Wohns D.
        • Dixon S.R.
        • Slocum N.K.
        • et al.
        Outcomes after percutaneous coronary intervention in patients with a history of cerebrovascular disease: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
        Circ Cardiovasc Interv. 2018; 11e006400
        • Su X.
        • Yan B.
        • Wang L.
        • Lv J.
        • Cheng H.
        • Chen Y.
        Effect of antiplatelet therapy on cardiovascular and kidney outcomes in patients with chronic kidney disease: a systematic review and meta-analysis.
        BMC Nephrol. 2019; 20: 309
        • Ishigami J.
        • Grams M.E.
        • Naik R.P.
        • Coresh J.
        • Matsushita K.
        Chronic kidney disease and risk for gastrointestinal bleeding in the community: The Atherosclerosis Risk in Communities (ARIC) Study.
        Clin J Am Soc Nephrol. 2016; 11: 1735-1743
        • Liang C.C.
        • Wang S.M.
        • Kuo H.L.
        • Chang C.T.
        • Liu J.H.
        • Lin H.H.
        • et al.
        Upper gastrointestinal bleeding in patients with CKD.
        Clin J Am Soc Nephrol. 2014; 9: 1354-1359
        • Latif F.
        • Kleiman N.S.
        • Cohen D.J.
        • Pencina M.J.
        • Yen C.H.
        • Cutlip D.E.
        • et al.
        In-hospital and 1-year outcomes among percutaneous coronary intervention patients with chronic kidney disease in the era of drug-eluting stents: a report from the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry.
        JACC Cardiovasc Interv. 2009; 2: 37-45
        • Lee J.M.
        • Kang J.
        • Lee E.
        • Hwang D.
        • Rhee T.M.
        • Park J.
        • et al.
        Chronic kidney disease in the second-generation drug-eluting stent era: pooled analysis of the Korean Multicenter Drug-Eluting Stent Registry.
        JACC Cardiovasc Interv. 2016; 9: 2097-2109
        • Kim Y.H.
        • Her A.Y.
        • Choi B.G.
        • Choi S.Y.
        • Byun J.K.
        • Park Y.
        • et al.
        Routine angiographic follow-up versus clinical follow-up in patients with diabetes following percutaneous coronary intervention with drug-eluting stents in Korean population.
        Diabetes Res Clin Pract. 2018; 138: 138-148
        • Goto K.
        • Zhao Z.
        • Matsumura M.
        • Dohi T.
        • Kobayashi N.
        • Kirtane A.J.
        • et al.
        Mechanisms and patterns of intravascular ultrasound in-stent restenosis among bare metal stents and first- and second-generation drug-eluting stents.
        Am J Cardiol. 2015; 116: 1351-1357
        • Hoffmann R.
        • Mintz G.S.
        • Dussaillant G.R.
        • Popma J.J.
        • Pichard A.D.
        • Satler L.F.
        • et al.
        Patterns and mechanisms of in-stent restenosis. A serial intravascular ultrasound study.
        Circulation. 1996; 94: 1247-1254