To Compare the Outcomes of Percutaneous Coronary Intervention and Conservative Strategy on Coronary Artery Disease with the Chronic Kidney Disease Patients

Shingamlung Kamei, Mathew Iype, Sivaprasad K, VV Radhakrishnan, Cibu Mathew

Abstract: Background: The beneficial effects of revascularization in patients with coronary artery disease (CAD) with chronic kidney disease (CKD) patients remain uncertain, since most often this population were excluded from the studies on revascularization. The aim of the study was to analyze the outcomes between invasive and conservative treatment in this population. Methods: This was a single center, prospective study compared coronary artery disease with chronic kidney disease patients (CAD CKD) with either invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The outcome studied was a composite of death or nonfatal myocardial infarction, non - fatal stroke, re - hospitalization for unstable angina or heart failure, bleeding complication, acute kidney injury requiring dialysis. Results: CAD CKD cohort was predominantly male (85%) with mean age of 60.02 ? 9.95 years. They had higher cardiovascular risk factors like diabetes mellitus (70 %) and hypertension (89 %). The composite outcome of in - hospital death in conservative 3 (4.10%) and invasive 6 (8.9 %) (p=0.2407).7 months follow up mortality, conservative 7 (9.5%) and invasive 3 (4.4%) (p=0.2407). In - hospital heart failure occurred in 13.7% patients in conservative group and in 11.9% in invasive group (p=0.7561). Heart failure at 7 months follow up occurred in 24.6% patients in conservative and 8.9% patients in invasive group respectively (p=0.042). Re - hospitalization occurred in 31.5% in the conservative and 16.4% patients in the invasive groups (p=0.0375). Acute kidney injury requiring dialysis, occurred in 19.2% patients in the conservative and 29.9% patients in the invasive groups (p=0.1412). Non - fatal MI occurred in 9.6% patients in the conservative and 4.5% patients in invasive groups (p=0.2407). Conclusion: In this study there is no evidence that an invasive strategy, as compared with conservative strategy, reduced the risk of death or nonfatal myocardial infarction. However heart failure and rehospitalization events were reduced in invasive group. There was no difference in the bleeding complications and acute kidney injury requiring dialysis in the conservative and invasive groups.

Keywords: Coronary artery disease (CAD), Chronic kidney disease (CKD), Percutaneous coronary intervention (PCI), Acute coronary syndrome (ACS), Chronic coronary syndrome (CCS)