Patients With CKD Have Higher Risk of HFrEF After PCI

A recent study aimed to characterize the impact of chronic kidney disease (CKD), an increasingly common condition, on incident heart failure with reduced ejection fraction (HFrEF) outcomes in patients with coronary artery disease (CAD) who have undergone percutaneous coronary intervention (PCI). CAD is a principal cause of heart failure (HF), and patients living with CAD are at a high risk of incident HFrEF.

Past studies suggest the proportion of patients with CKD undergoing PCI is increasing. Patients with CKD are also prone to cardiovascular issues, such as recurrent myocardial infarction (MI), HF, and stroke; systemic inflammation; and other comorbidities. Whether CKD is an independent risk factor for incident HFeEF after PCI, however, has not been made clear.

The current study, published in Frontiers in Cardiovascular Medicine, included patients undergoing PCI with left ventricular ejection fraction (LVEF) of 40% or more at baseline and explored the association of CKD with incident HFrEF. Baseline data were sourced from the registry of the Cardiorenal Improvement study, which included patients at Guangdong Provincial People’s Hospital in China.

A total of 2356 patients with a mean age of 62 years were included in the study. In the overall cohort, 1421 patients (60.3%) had hypertension, 730 (31%) had diabetes, 240 (10.2%) had congestive HF (CHF), 634 (26.9%) had acute MI, 123 (5.2%) had valvular heart disease, and 62 (2.6%) had atrial fibrillation (AFib). Patients were stratified into a CKD group and a non-CKD cohort.

A total of 435 (18.5%) had CKD, defined as an estimated glomerular filtration rate of less than 60 mL/min/1.73m², and 83 (3.5%) developed incident HFrEF following PCI, defined as a follow-up LVEF of less than 40% within 3 to 12 months of discharge. The study did not include patients with no baseline LVEF data, those with baseline LVEF less than 40%, those missing 3 to 12-month follow-up LVEF information after discharge, a lack of pre- or post-operative creatinine data, or patients who died in the year after PCI.

A multivariate logistic regression analysis showed CKD to be an independent risk factor for post-PDI HRfEF. After adjusting for confounders—including age, gender, diabetes, hypertension, AFib, CHF, baseline LVEF, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins—the odds ratio was 1.75 (95% CI, 1.03-2.92; P = .035) for incident HFeEF in patients with CKD vs those without CKD.

The incident HFrEF rate in the CKD group was 6.9% compared with 2.8% in the non-CKD cohort (P = .001). Patients with HFrEF also had a higher ratio of all-cause mortality vs those who did not: 26.5% vs 8.1%

These findings suggest that identifying these high-risk patients and treating them accordingly with cardioprotective measures can help improve prognosis. Given the prevalence of CKD in patients undergoing PCI, improving renal function assessment and screening patients thoroughly ahead of PCI is an important step for clinicians, the authors noted.

“Incorporation of CKD in incident HFrEF risk assessment of patients with CAD undergoing PCI can help optimize the selection of high-risk patients who have the potential to obtain the largest advantage of more aggressive cardioprotective prevention treatments,” the authors wrote.

Study limitations included the single-center and retrospective nature of the research and the lack of causal conclusions. Longer-term follow-up is also necessary in ongoing research, the authors note.

Reference

Lai W, Zhao X, Yu S, et al. Chronic kidney disease increases risk of incident HFrEF following percutaneous coronary intervention. Front Cardiovasc Med. Published online April 1, 2022. doi:10.3389/fcvm.2022.856602