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Ayayo SA, Kontopantelis E, Martin GP, Zghebi SS, Taxiarchi VP, Mamas MA. Temporal trends of in-hospital mortality and its determinants following percutaneous coronary intervention in patients with acute coronary syndrome in England and Wales: A population-based study between 2006 and 2021. Int J Cardiol 2024; 412:132334. [PMID: 38964546 DOI: 10.1016/j.ijcard.2024.132334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND There is limited data around drivers of changes in mortality over time. We aimed to examine the temporal changes in mortality and understand its determinants over time. METHODS 743,149 PCI procedures for patients from the British Cardiovascular Intervention Society (BCIS) database who were aged between 18 and 100 years and underwent Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS) in England and Wales between 2006 and 2021 were included. We decomposed the contributing factors to the difference in the observed mortality proportions between 2006 and 2021 using Fairlie decomposition method. Multiple imputation was used to address missing data. RESULTS Overall, there was an increase in the mortality proportion over time, from 1.7% (95% CI: 1.5% to 1.9%) in 2006 to 3.1% (95% CI: 3.0% to 3.2%) in 2021. 61.2% of this difference was explained by the variables included in the model. ACS subtypes (percentage contribution: 14.67%; 95% CI: 5.76% to 23.59%) and medical history (percentage contribution: 13.50%; 95% CI: 4.33% to 22.67%) were the strongest contributors to the difference in the observed mortality proportions between 2006 and 2021. Also, there were different drivers to mortality changes between different time periods. Specifically, ACS subtypes and severity of presentation were amongst the strongest contributors between 2006 and 2012 while access site and demographics were the strongest contributors between 2012 and 2021. CONCLUSIONS Patient factors and the move towards ST-elevated myocardial infarction (STEMI) PCI have driven the short-term mortality changes following PCI for ACS the most.
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Affiliation(s)
- Sharon A Ayayo
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK.
| | | | - Glen P Martin
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK.
| | - Salwa S Zghebi
- Division of Population Health, Health Services Research and Primary care, The University of Manchester, UK.
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, Division of Psychology and Mental Health, The University of Manchester, UK.
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK; National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, UK.
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Fraund-Cremer S, Hoffmann G, Arndt J, Borzikowsky C, Huenges K, Thiem A, Haneya A, Panholzer B, Attmann T, Duemmler J, Cremer J, Grothusen C. Long-term follow-up of patients with complex coronary artery disease treated with minimally invasive direct coronary artery bypass. Cardiol J 2023; 30:1003-1009. [PMID: 37964645 PMCID: PMC10713227 DOI: 10.5603/cj.94716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/29/2023] [Accepted: 09/27/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Patients with complex coronary artery disease (CAD) may benefit from surgical myocardial revascularization but weighing the risk of peri-operative complications against the expected merit is difficult. Minimally invasive direct artery bypass (MIDCAB) procedures are less invasive, provide the prognostic advantage of operative revascularization of the left anterior descending artery and may be integrated in hybrid strategies. Herein, the outcomes between patients with coronary 1-vessel disease (1-VD) and patients with 2-VD and 3-VD after MIDCAB procedures were compared in this single-center study. METHODS Between 1998 and 2018, 1363 patients underwent MIDCAB at the documented institution. 628 (46.1%) patients had 1-VD, 434 (31.9%) patients 2-VD and 300 (22.0%) patients suffered from 3-VD. Data of patients with 2-VD, and 3-VD were pooled as multi-VD (MVD). RESULTS Patients with MVD were older (66.2 ± 10.9 vs. 62.9 ± 11.2 years; p < 0.001) and presented with a higher EuroScore II (2.10 [0.4; 34.2] vs. 1.2 [0.4; 12.1]; p < 0.001). Procedure time was longer in MVD patients (131.1 ± 50.3 min vs. 122.2 ± 34.5 min; p < 0.001). Post-operatively, MVD patients had a higher stroke rate (17 [2.3%] vs. 4 [0.6%]; p = 0.014). No difference in 30-day mortality was observed (12 [1.6%] vs. 4 [0.6%]; p = 0.128). Survival after 15 years was significantly lower in MVD patients (p < 0.01). Hybrid procedures were planned in 295 (40.2%) patients with MVD and realized in 183 (61.2%) cases. MVD patients with incomplete hybrid procedures had a significantly decreased long-term survival compared to cases with complete revascularization (p < 0.01). CONCLUSIONS Minimally invasive direct coronary artery bypass procedures are low-risk surgical procedures. If hybrid procedures have been planned, completion of revascularization should be a major goal.
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Affiliation(s)
- Sandra Fraund-Cremer
- Department of Cardiac and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Grischa Hoffmann
- Department of Cardiac and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Juliane Arndt
- Department of Cardiac and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Katharina Huenges
- Department of Cardiac and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Alexander Thiem
- Department of Cardiac and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Bernd Panholzer
- Department of Cardiac and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Tim Attmann
- Department of Cardiac and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Johannes Duemmler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Jochen Cremer
- Department of Cardiac and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Christina Grothusen
- Department of Cardiac and Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany.
- Department of Internal Medicine I, St. Johannes-Hospital, Dortmund, Germany.
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Patient Characteristics, Procedural Details, and Outcomes of Contemporary Percutaneous Coronary Intervention in Real-World Practice: Insights from Nationwide Thai PCI Registry. J Interv Cardiol 2022; 2022:5839834. [PMID: 35935123 PMCID: PMC9296290 DOI: 10.1155/2022/5839834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) practice and outcomes vary substantially in different parts of the world. The contemporary data of PCI in Asia are limited and only available from developed Asian countries. Objectives To explore the pattern of practice and results of PCI procedures in Thailand as well as a temporal change of PCI practice over time compared with the registry from other countries. Methods Thai PCI Registry is a prospective nationwide registry that was an initiative of the Cardiac Intervention Association of Thailand (CIAT). All cardiac catheterization laboratories in Thailand were invited to participate during 2018-2019, and consecutive PCI patients were enrolled and followed up for 1 year. Patient baseline characteristics, procedural details, equipment and medication use, outcomes, and complications were recorded. Results Among the 39 hospitals participated, there were 22,741 patients included in this registry. Their mean age (standard deviation) was 64.2 (11.7) years and about 70% were males. The most common presentation was acute coronary syndrome (57%) with a high proportion of ST-elevation myocardial infarction (28%). Nearly two-thirds of patients had multivessel disease and significant left main stenosis was reported in 11%. The transradial approach was used in 44.2%. The procedural success rate was very high (95.2%) despite the high complexity of the lesions (56.9% type C lesion). The incidence of procedural complications was 5.3% and in-hospital mortality was 2.8%. Conclusion Thai PCI Registry provides further insights into the current practice and outcomes of PCI in Southeast Asia. The success rate was very high, and the complications were very low despite the high complexity of the treated lesions.
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Choi JM, Lee SH, Choi JH. Ten-year trends of clinical outcomes after percutaneous coronary intervention: a Korean nationwide longitudinal cohort study. BMJ Open 2022; 12:e056972. [PMID: 35443956 PMCID: PMC9021814 DOI: 10.1136/bmjopen-2021-056972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Mortality following percutaneous coronary intervention (PCI) is a key quality measurement in clinical practice. This study investigated the 10-year trends of mortality following PCI in an unselected nationwide cohort. DESIGN Retrospective cohort study. SETTING A nationwide study in South Korea. PARTICIPANTS PCI claim data from 2006 to 2015 of the National Health Insurance Service and the Statistics of Korea. MEASURES 1-year cardiovascular or non-cardiovascular death. RESULTS In total, 437 436 patients were included. The annual number of PCI cases increased from 32 098 to 51 990 over the decade studied (p<0.001). Patients were divided into quartile subgroups according to an estimated adjusted probability for predicting 1-year all-cause death. The proportion of patients in the high-risk quartiles increased whereas those in the low-risk quartiles decreased (p<0.001). The 1-year cumulative incidence rate of all-cause death did not change in the population with risk scores in the 1st (0.9% to 0.8%) and 2nd (1.3% to 1.3%) quartiles, whereas it increased in the population with risk scores in the 3rd (3.4% to 5.1%) and 4th (15.5% to 19.4%) quartiles (p<0.001). Compared with year 2006, the mean survival time in year 2015 was shorter by 0, 3.3 and 12.4 days in patients with risk scores in the 1st or 2nd, 3rd and 4th quartiles, respectively. These findings were also consistent for cardiovascular or non-cardiovascular deaths. CONCLUSION The number, proportion and the overall risk of patients with a high risk for mortality after PCI increased over the decade in Korea.
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Affiliation(s)
- Jung Min Choi
- Department of Medical Device Research and Management, Samsung Advanced Institute for Health Sciences & Technology, Seoul, South Korea
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hwa Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seou, Republic of Korea
| | - Jin-Ho Choi
- Emergency Medicine, Samsung Medical Center, Gangnam-gu, South Korea
- Samsung Advanced Institute for Health Sciences & Technology, Seoul, South Korea
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One-year outcome after percutaneous coronary intervention in nonagenarians: Insights from the J-PCI OUTCOME registry. Am Heart J 2022; 246:105-116. [PMID: 35016854 DOI: 10.1016/j.ahj.2022.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/24/2021] [Accepted: 01/06/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Nonagenarian patients who undergo percutaneous coronary intervention (PCI) are increasing, and a few previous studies have reported their long-term outcomes. However, differences in their long-term outcomes between generations remain unclear. This study aimed to investigate 1-year all-cause and cardiovascular (CV) mortality, and major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, and stroke) of nonagenarian patients who underwent PCI compared with the other elder patients, using a nationwide registration system. METHODS The patient-level data registered between January 2017 and December 2017 was extracted from the J-PCI OUTCOME Registry endorsed by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT). The one-year all-cause and cardiovascular (CV) mortality, MACE, and major bleeding events were identified. RESULTS Out of 40,722 patients over 60 years of age, 880 (2.1%) were nonagenarians. For nonagenarians, the 1-year mortality rate was substantial (13.5%). The MACE and CV death rates were also high (8.1%, and 6.8%, respectively) for nonagenarians, and these event rates were approximately 1.5 times higher in nonagenarians than octogenarians. Multivariate regression analysis showed that presentation with cardiogenic shock [hazard ratio (HR) 2.32; 95 confidence intervals (CI): 1.22-4.41], or cardiac arrest (HR 2.91; 90% CI: 1.28-6.62), and use of oral anticoagulants (HR 2.10; 90% CI: 1.07-4.12) were the predictors of 1-year MACE. CONCLUSIONS Even in the contemporary era, nonagenarians who have undergone PCI still face a considerably increased risk for adverse cardiovascular events that reduces long-term survival. In addition to having poorer lesion characteristics, adverse events, including death, MACEs, and major bleeding, occurred 1.5 times more frequently in nonagenarians than in octogenarians.
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Asano T, Ono M, Dai Z, Saito A, Kanie T, Takaoka Y, Mizuno A, Yoneoka D, Komiyama N. Temporal trends in clinical outcomes after percutaneous coronary intervention: a systematic review of 66,327 patients from 25 all-comers trials. EUROINTERVENTION 2022; 17:1318-1329. [PMID: 34602385 PMCID: PMC9743235 DOI: 10.4244/eij-d-21-00192] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND With the improvements of percutaneous coronary intervention (PCI) technology and post-PCI patient management, several registry studies reported temporal trends in post-PCI clinical outcomes. However, their results are inconclusive, potentially reflecting region-specific trends, based on site-reported events without external validity. AIMS This study aimed to investigate temporal trends in post-PCI clinical outcomes in all-comers randomised controlled trials (RCTs) involving coronary stents. METHODS We performed a systematic review identifying RCTs comparing a clinical outcome as a primary endpoint among different coronary stents with an all-comers design and independent clinical event adjudication, extracting the study start year, patient baseline characteristics, and one- and five-year clinical outcomes. Temporal trends in clinical outcomes (cardiac death, myocardial infarction [MI], target lesion revascularisation [TLR], stent thrombosis [ST]) were assessed using random-effects meta-regression analyses, estimating the relationship between clinical outcomes and study start year. RESULTS Overall, 25 all-comers trials (51 device arms, 66,327 patients) conducted between 2003 and 2018 fulfilled the eligibility criteria. Random-effects meta-regression analysis revealed significant decreasing trends in one- and five-year cardiac death, one-year TLR, and five-year ST incidences (relative risk per 10-year increase: 0.69 [0.51-0.92], 0.66 [0.44-0.98], 0.60 [0.41-0.88], and 0.18 [0.07-0.44], respectively). There was no significant trend in myocardial infarction incidences. CONCLUSIONS This is the first attempt to clarify and quantify the temporal trends of post-PCI outcome incidence. The 15-year improvements in PCI therapy and post-therapeutic patient management are associated with reduced incidences of cardiac death and PCI-related adverse events.
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Affiliation(s)
- Taku Asano
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Masafumi Ono
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.,Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Zhehao Dai
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Saito
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Takayoshi Kanie
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Yoshimitsu Takaoka
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan.,The Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Daisuke Yoneoka
- Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Nobuyuki Komiyama
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
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Lee P, Brennan AL, Stub D, Dinh DT, Lefkovits J, Reid CM, Zomer E, Liew D. Estimating the economic impacts of percutaneous coronary intervention in Australia: a registry-based cost burden study. BMJ Open 2021; 11:e053305. [PMID: 34876433 PMCID: PMC8655558 DOI: 10.1136/bmjopen-2021-053305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES In this study, we sought to evaluate the costs of percutaneous coronary intervention (PCI) across a variety of indications in Victoria, Australia, using a direct per-person approach, as well as to identify key cost drivers. DESIGN A cost-burden study of PCI in Victoria was conducted from the Australian healthcare system perspective. SETTING A linked dataset of patients admitted to public hospitals for PCI in Victoria was drawn from the Victorian Cardiac Outcomes Registry (VCOR) and the Victorian Admitted Episodes Dataset. Generalised linear regression modelling was used to evaluate key cost drivers. From 2014 to 2017, 20 345 consecutive PCIs undertaken in Victorian public hospitals were captured in VCOR. PRIMARY OUTCOME MEASURES Direct healthcare costs attributed to PCI, estimated using a casemix funding method. RESULTS Key cost drivers identified in the cost model included procedural complexity, patient length of stay and vascular access site. Although the total procedural cost increased from $A55 569 740 in 2014 to $A72 179 656 in 2017, mean procedural costs remained stable over time ($A12 521 in 2014 to $A12 185 in 2017) after adjustment for confounding factors. Mean procedural costs were also stable across patient indications for PCI ($A9872 for unstable angina to $A15 930 for ST-elevation myocardial infarction) after adjustment for confounding factors. CONCLUSIONS The overall cost burden attributed to PCIs in Victoria is rising over time. However, despite increasing procedural complexity, mean procedural costs remained stable over time which may be, in part, attributed to changes in clinical practice.
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Affiliation(s)
- Peter Lee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Curtin University, Perth, Western Australia, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Dawson LP, Dinh D, Duffy SJ, Clark D, Reid CM, Brennan A, Andrianopoulos N, Hiew C, Freeman M, Oqueli E, Chan W, Ajani AE. Temporal Trends in Patient Risk Profile and Clinical Outcomes Following Percutaneous Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 31:10-16. [DOI: 10.1016/j.carrev.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
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Yun D, Choi Y, Lee SP, Park KW, Koo BK, Kim HS, Kim DK, Joo KW, Kim YS, Han SS. Blood Pressure and Renal Progression in Patients Undergoing Percutaneous Coronary Intervention. Am J Hypertens 2020; 33:676-684. [PMID: 32179915 DOI: 10.1093/ajh/hpaa046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High blood pressure (BP) may impair renal function following percutaneous coronary intervention (PCI). However, the predictability of renal progression based on admission and discharge BP and BP threshold values remains unclear. METHODS A total of 8,176 adult patients who underwent PCI at Seoul National University Hospital from 2006 to 2016 were retrospectively analyzed. Renal progression was defined as a doubling of serum creatinine levels, ≥50% decrease of the estimated glomerular filtration rate, or development of end-stage renal disease. The risk of renal progression according to admission BP (any time) and discharge BP (8:00-10:00 am) was evaluated by multivariable Cox and additive generalized models with penalized splines. RESULTS During a median follow-up of 7 years (maximum: 13 years), 9.3% of patients (n = 758) reached renal progression. BP between admission and discharge showed a low correlation, and all BP parameters showed a nonlinear relationship with renal progression. Systolic BP at discharge (SBPd) was selected as the best predictor of renal progression because the delta for the Akaike information criterion from the baseline model to the model with BP parameters was the lowest. The risk of renal progression started to increase at SBPd ≥ 125 mm Hg. This increasing risk of renal progression with SBPd ≥ 125 mm Hg remained significant, despite adjusting for the competing risk of all-cause death. CONCLUSIONS High SBPd is associated with renal progression following PCI, particularly when it is ≥125 mm Hg. This can be used as a risk classification and potential target of renoprotective therapies.
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Affiliation(s)
- Donghwan Yun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Nephrology, Seoul National University Hospital, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Nephrology, Seoul National University Hospital, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Nephrology, Seoul National University Hospital, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Nephrology, Seoul National University Hospital, Seoul, Korea
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