Combined presence of CKD and diabetes tied to poor prognosis in women undergoing PCI: Study

The study showed that the combination was tied to an increased risk of myocardial infarction (MI), stent thrombosis, and all-cause death after percutaneous coronary intervention (PCI).

"Among women receiving drug-eluting stent (DES) implantation, the combined presence of chronic kidney disease and diabetes was associated with a higher risk of the composite of MI or death and any secondary outcome," the researchers reported. "However, each condition alone was associated with an increase in all-cause and cardiac death."

In patients undergoing PCI, diabetes and CKD are two common comorbid conditions and are associated with increased mortality and morbidity, especially when both are present. Women undergoing PCI sustain poorer clinical outcomes than men, due to a higher burden of comorbidities and their older age, including diabetes and CKD. Prior studies that assessed how the presence of CKD and diabetes affect cardiovascular outcomes in women undergoing PCI considered the prognostic impact of these conditions separately and not in combination.

Alessandro Spirito, Icahn School of Medicine at Mount Sinai, New York, NY, USA, and colleagues sought to assess the impact of CKD and DM on prognosis in women after DES implantation.

For this purpose, the researchers pooled data on women from 26 RCTs (randomized controlled trials) comparing stent types. Women receiving DES were stratified into four groups based on CKD (defined as creatine clearance <60 mL/min) and diabetes status.

The primary outcome three years after PCI was the composite of all-cause death or myocardial infarction. Secondary outcomes included stent thrombosis, cardiac death and target lesion revascularization.

The authors reported the following findings:

• Among 4,269 women, 42.7% had no CKD/DM, 22.9% had CKD alone, 23.0% had DM alone, and 11.4% had both conditions.
• The risk of all-cause death or MI was not increased in women with CKD alone (adj. hazard ratio [HR] 1.19) nor DM alone (adj. HR 1.27) but was significantly higher in women with both conditions (adj. HR 2.64).
• CKD and DM in combination were associated with an increased risk of all secondary outcomes, whereas alone, each condition was only associated with all-cause death and cardiac death.

“Our study provides valuable insights on how the prognosis of women undergoing PCI is impacted by the interaction between diabetes and CKD and underscores the utility of stratifying women according to these two comorbidities for decision-making on therapy and further management,” the researchers concluded.

Reference:

Spirito A, Itchhaporia D, Sartori S, Camenzind E, Chieffo A, Dangas GD, Galatius S, Jeger RV, Kandzari DE, Kastrati A, Kim HS, Kimura T, Leon MB, Mehta LS, Mikhail GW, Morice MC, Nicolas J, Pileggi B, Serruys PW, Smits PC, Steg PG, Stone GW, Valgimigli M, Vogel B, von Birgelen C, Weisz G, Wijns W, Windecker S, Mehran R. Impact of chronic kidney disease and diabetes on clinical outcomes in women undergoing PCI. EuroIntervention. 2023 Jun 28:EIJ-D-23-00086. doi: 10.4244/EIJ-D-23-00086. Epub ahead of print. PMID: 37382924.