Association of chronic kidney disease with periprocedural myocardial injury after elective stent implantation

    Authors

    Keywords

    coronary artery disease, chronic kidney disease, periprocedural myocardial injury

    DOI

    https://doi.org/10.15836/ccar2016.463

    Full Text

    **Objectives**: Coronary artery disease (CAD) is the leading cause of mortality in patients with chronic kidney disease (CKD). Patients with CKD who undergo coronary revascularization may have more ischemic events than patients without CKD (1). The aim of this study was to determine the incidence and intensity of periprocedural myocardial injury (PMI) after elective stent implantation among patients with and without CKD. **Patients and Methods**: This study prospectively included 344 consecutive patients with stable angina pectoris who underwent an elective PCI at Merkur University Hospital, Zagreb, Croatia, in a period between March 2012 and June 2015 (**Table 1**). Patients were divided into two groups: control group with estimated glomerular filtration rate (eGFR) > 90 ml/min/1.73m2 and the CKD group with eGFR 2, with further subdivision according to CKD stage. Serum troponin I (cTnI) concentrations were measured at baseline and at 8 and 16 hours after PCI. Periprocedural increase of cTnI above the upper reference limit (URL) was defined as PMI. If cTnI increase ≥ 5x URL, it was considered a PMI of high degree, while an increase to 90 ml/min/1.73 m2** **(n= 128)** | **eGFR** **2** **(n= 216)** | **p value** | | --- | --- | --- | --- | | **Male, n (%)** | 102 (79.6) | 140 (64.8) | 30 kg/m2 (%)** | 38 (29.6) | 73 (33.7) | 0.43 | | **Hypertension, n (%)** | 112 (87.5) | 201 (93.0) | 0.08 | | **Hyperlipidemia (%)** | 107 (83.6) | 186 (86.1) | 0.64 | | **Diabetes mellitus, n (%)** | 38 (29.6) | 83 (38.4) | 0.10 | | **Current smoker, n (%)** | 37 (28.9) | 33 (15.3) | <0.01 | | **Previous PCI, n (%)** | 43 (33.6) | 65 (30.1) | 0.50 | | **Previous CABG, n (%)** | 3 (2.3) | 9 (4.1) | 0.37 | | **Medication:** | | | | | **ACE inhibitors, n (%)** | 107 (83.6) | 188 (87.1) | 0.47 | | **ARB, n (%)** | 11 (8.6) | 22 (10.2) | 0.62 | | **Beta blockers, n (%)** | 110 (85.9) | 177 (81.9) | 0.50 | | **Lipid-lowering drugs, n (%)** | 106 (82.8) | 188 (87.1) | 0.23 | [†] eGFR = estimated glomerular filtration rate; BMI = body mass index; CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention; ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blocker **Results**: There were no significant differences in incidence of PMI between control and CKD group after 8 hours (47.6% vs 44.9%, p=0.62) or after 16 hours (64.8% vs. 61.6%, p=0.55). There were also no significant differences in intensity of PMI between control and CKD group after 8 hours (0.13 ± 0.33 vs 0.11 ± 0.21, p= 0,58)) or after 16 hours (0.24 ± 0.46 vs 0.29 ± 0.86, p=0.61). We further assessed incidence and severity of PMI with respect to CKD burden (i.e. CKD stage) and we found no significant differences in the incidence or intensity of PMI 8 and 16 h after PCI in groups according to the eGFR (**Figure 1**, **Figure 2**). Figure 1. Incidence of periprocedural myocardial injury 8 h after percutaneous coronary intervention according to the estimated glomerular filtration rate. eGFR = estimated glomerular filtration rate; PMI = periprocedural myocardial injury Figure 2. Incidence of periprocedural myocardial injury 16 h after percutaneous coronary intervention according to the estimated glomerular filtration rate. eGFR = estimated glomerular filtration rate; PMI = periprocedural myocardial injury **Conclusion**: We found no association between incidence or intensity of PMI and the presence of CKD. Furthermore, CKD burden (i.e. stratification of patients according to the CKD stage) was also not associated with higher incidence or intensity of PMI after elective PCI.

    Literature

    1. Parikh PB, Jeremias A, Naidu SS, Brener SJ, Lima F, Shlofmitz RA, et al. Impact of severity of renal dysfunction on determinants of in-hospital mortality among patients undergoing PCI. Catheter Cardiovasc Interv. 2012;80(3):352–7. https://doi.org/10.1002/ccd.23394
    2. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction; ESC Committee for Practice Guidelines (CPG). Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551–67. https://doi.org/10.1093/eurheartj/ehs184
    Cardiologia Croatica
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    Association of chronic kidney disease with periprocedural myocardial injury after elective stent implantation

    Extended Abstract
    Issue10-11
    Published
    Pages463-464
    PDF via DOIhttps://doi.org/10.15836/ccar2016.463
    coronary artery disease
    chronic kidney disease
    periprocedural myocardial injury

    Authors

    Helena Jerkić*ORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Mario StipinovićORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Darko PočanićORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Stjepan KranjčevićORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Damir KozmarORCIDUniversity Hospital Merkur, Zagreb, Croatia
    Tomislav LetilovićORCIDUniversity Hospital Merkur, Zagreb, Croatia

    *Correspondence email: helenajerkic@yahoo.com

    Full Text

    Objectives: Coronary artery disease (CAD) is the leading cause of mortality in patients with chronic kidney disease (CKD). Patients with CKD who undergo coronary revascularization may have more ischemic events than patients without CKD (1). The aim of this study was to determine the incidence and intensity of periprocedural myocardial injury (PMI) after elective stent implantation among patients with and without CKD.

    Patients and Methods: This study prospectively included 344 consecutive patients with stable angina pectoris who underwent an elective PCI at Merkur University Hospital, Zagreb, Croatia, in a period between March 2012 and June 2015 (Table 1). Patients were divided into two groups: control group with estimated glomerular filtration rate (eGFR) > 90 ml/min/1.73m2 and the CKD group with eGFR 2, with further subdivision according to CKD stage. Serum troponin I (cTnI) concentrations were measured at baseline and at 8 and 16 hours after PCI. Periprocedural increase of cTnI above the upper reference limit (URL) was defined as PMI. If cTnI increase ≥ 5x URL, it was considered a PMI of high degree, while an increase to < 5x URL was considered a PMI of low degree (2).

    Table 1: Baseline characteristics of the study participants.

    Male, n (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    102 (79.6)
    eGFR 2 (n= 216)
    140 (64.8)
    p value
    <0.01
    Age, years
    eGFR >90 ml/min/1.73 m2 (n= 128)
    59.7 ± 8.1
    eGFR 2 (n= 216)
    67.1 ± 10.2
    p value
    <0.01
    BMI>30 kg/m2 (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    38 (29.6)
    eGFR 2 (n= 216)
    73 (33.7)
    p value
    0.43
    Hypertension, n (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    112 (87.5)
    eGFR 2 (n= 216)
    201 (93.0)
    p value
    0.08
    Hyperlipidemia (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    107 (83.6)
    eGFR 2 (n= 216)
    186 (86.1)
    p value
    0.64
    Diabetes mellitus, n (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    38 (29.6)
    eGFR 2 (n= 216)
    83 (38.4)
    p value
    0.10
    Current smoker, n (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    37 (28.9)
    eGFR 2 (n= 216)
    33 (15.3)
    p value
    <0.01
    Previous PCI, n (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    43 (33.6)
    eGFR 2 (n= 216)
    65 (30.1)
    p value
    0.50
    Previous CABG, n (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    3 (2.3)
    eGFR 2 (n= 216)
    9 (4.1)
    p value
    0.37
    Medication:
    ACE inhibitors, n (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    107 (83.6)
    eGFR 2 (n= 216)
    188 (87.1)
    p value
    0.47
    ARB, n (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    11 (8.6)
    eGFR 2 (n= 216)
    22 (10.2)
    p value
    0.62
    Beta blockers, n (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    110 (85.9)
    eGFR 2 (n= 216)
    177 (81.9)
    p value
    0.50
    Lipid-lowering drugs, n (%)
    eGFR >90 ml/min/1.73 m2 (n= 128)
    106 (82.8)
    eGFR 2 (n= 216)
    188 (87.1)
    p value
    0.23

    eGFR = estimated glomerular filtration rate; BMI = body mass index; CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention; ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blocker

    Results: There were no significant differences in incidence of PMI between control and CKD group after 8 hours (47.6% vs 44.9%, p=0.62) or after 16 hours (64.8% vs. 61.6%, p=0.55). There were also no significant differences in intensity of PMI between control and CKD group after 8 hours (0.13 ± 0.33 vs 0.11 ± 0.21, p= 0,58)) or after 16 hours (0.24 ± 0.46 vs 0.29 ± 0.86, p=0.61). We further assessed incidence and severity of PMI with respect to CKD burden (i.e. CKD stage) and we found no significant differences in the incidence or intensity of PMI 8 and 16 h after PCI in groups according to the eGFR (Figure 1, Figure 2).

    Figure 1. Incidence of periprocedural myocardial injury 8 h after percutaneous coronary intervention according to the estimated glomerular filtration rate. eGFR = estimated glomerular filtration rate; PMI = periprocedural myocardial injury

    Figure 2. Incidence of periprocedural myocardial injury 16 h after percutaneous coronary intervention according to the estimated glomerular filtration rate. eGFR = estimated glomerular filtration rate; PMI = periprocedural myocardial injury

    Conclusion: We found no association between incidence or intensity of PMI and the presence of CKD. Furthermore, CKD burden (i.e. stratification of patients according to the CKD stage) was also not associated with higher incidence or intensity of PMI after elective PCI.

    Literature

    1. 1.
      Parikh PB, Jeremias A, Naidu SS, Brener SJ, Lima F, Shlofmitz RA, et al. Impact of severity of renal dysfunction on determinants of in-hospital mortality among patients undergoing PCI. Catheter Cardiovasc Interv. 2012;80(3):352–7.DOI
    2. 2.
      Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction; ESC Committee for Practice Guidelines (CPG). Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551–67.DOI