Incidence of restenosis after drug-coated balloon percutaneous coronary intervention in patients with chronic kidney disease – a single-centre experience

    Authors

    Abstract

    **Introduction**: The efficiency of drug-coated balloon (DCB) percutaneous coronary intervention (PCI) has been shown for in-stent restenosis (ISR) and native small-vessel disease, with available data showing similar outcomes in both chronic kidney disease (CKD) and non-CKD patients (1). The aim is to compare the incidence of target lesion restenosis at follow-up (FUP) coronary angiography in patients with and without CKD receiving DCB PCI. **Patients and Methods**: The registry included patients undergoing a DCB PCI at the University Hospital Centre Zagreb from February 2011 to January 2023 (n=652). Patient demographics, comorbidities, pharmacotherapy, as well as data on the initial and FUP coronary angiography/PCI was collected. Chronic kidney disease was defined as estimated glomerular filtration rate < 45 ml/min/1.73m2. A FUP angiography was performed in 49% of patients (n=317), with a median FUP of 6 (interquartile range 3 - 18) months, without difference between groups. **Results**: Data is shown in **Table 1**. The cohort was 75% male, mean age 65 ± 10 years. CKD was present in 9% (n=57) of patients and was associated with a higher incidence of arterial hypertension, diabetes mellitus, atrial fibrillation, as well as peripheral artery disease. The age difference was noted between groups, with CKD patients being older on average. At initial PCI, more CKD patients had multivessel coronary disease, with a higher rate of ISR as the indication for DCB, that was not statistically significant (CKD vs non-CKD: 46% vs 34%, p=0.075). After DCB, no difference was noted between groups in regards to the need for a bail-out PCI (9% VS 6%, P=0.375). FUP was performed in an equal percentage of patients in both groups (48% vs 51%, p=0.769), with no differences seen in the incidence of restenosis (17% vs. 18%, p=0.998), the need for target lesion PCI (17% vs. 13%, p=0.533), or the use of anti-anginal drugs. ### TABLE 1: Comparison between chronic kidney disease (CKD) and non-CKD patients. | | | Patients with chronic kidney disease (n=57) | Patients without chronic kidney disease (n=585) | P -value | | --- | --- | --- | --- | --- | | Initial PCI hospitalization | | | | | | Age, years (mean ± SD) | | 72 ± 9 | 64 ± 10 | <0.001* | | Male sex, n (%) | | 38 (67) | 445 (76) | 0.147 | | History of myocardial infarction, n (%) | | 31 (54) | 246 (42) | 0.073 | | History of PCI, n (%) | | 39 (68) | 347 (59) | 0.180 | | History of CABG, n (%) | | 5 (9) | 21 (4) | 0.071 | | History of stroke or TIA, n (%) | | 7 (12) | 34 (6) | 0.057 | | History of atrial fibrillation, n (%) | | 19 (33) | 61 (10) | <0.001* | | History of peripheral artery disease, n (%) | | 11 (19) | 44 (8) | <0.002* | | Arterial hypertension, n (%) | | 55 (97) | 502 (86) | 0.022* | | Diabetes mellitus, n (%) | | 32 (56) | 190 (33) | <0.001* | | ACS as indication for DCB PCI, n (%) | | 25 (44) | 275 (47) | 0.679 | | Multivessel coronary disease, n (%) | | 39 (70) | 292 (50) | 0.013* | | In-stent restenosis, n (%) | | 25 (46) | 194 (34) | 0.075 | | Bail-out PCI, n (%) | | 5 (9) | 35 (6) | 0.375 | | Follow-up hospitalization | | | | | | Elective procedure, n (%) | | 18 (75) | 244 (84) | 0.261 | | Restenosis of target DCB PCI lesion, n (%) | FUP cohort (n= 317) | 4 (17) | 51 (18) | 0.998 | | Whole cohort (n=645) | 4 (7) | 51 (9) | 0.808 | | [†] SD – standard deviation, PCI – percutaneous coronary intervention, CABG – coronary artery bypass graft, TIA – transient ischemic attack, ACS – acute coronary syndrome, DCB – drug-coated balloon *p<0.05 **Conclusion**: The findings of our single-centre analysis show that patients with CKD do not have a higher risk of target lesion restenosis after DCB PCI, when compared to the non-CKD group, which is in accordance with currently available evidence (2).

    Keywords

    chronic coronary disease, drug-coated balloons, PCI, restenosis, chronic kidney disease

    DOI

    https://doi.org/10.15836/ccar2023.70

    Literature

    1. Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, et al. Drug-Coated Balloons for Coronary Artery Disease: Third Report of the International DCB Consensus Group. JACC Cardiovasc Interv. 2020 June 22;13(12):1391–402. https://doi.org/10.1016/j.jcin.2020.02.043
    2. Mahfoud F, Farah A, Ohlow MA, Mangner N, Wöhrle J, Möbius-Winkler S, et al. Drug-coated balloons for small coronary artery disease in patients with chronic kidney disease: a pre-specified analysis of the BASKET-SMALL 2 trial. Clin Res Cardiol. 2022 July;111(7):806–15. https://doi.org/10.1007/s00392-022-01995-3
    Cardiologia Croatica
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    Incidence of restenosis after drug-coated balloon percutaneous coronary intervention in patients with chronic kidney disease – a single-centre experience

    Extended Abstract
    Issue3-4
    Published
    Pages70-71
    PDF via DOIhttps://doi.org/10.15836/ccar2023.70
    chronic coronary disease
    drug-coated balloons
    PCI
    restenosis
    chronic kidney disease

    Authors

    Antonio Hanžek*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Zvonimir OstojićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Filip LončarićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Luka PerčinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Tomislav KrčmarORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Kristina Marić-BešićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor RadićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marijan PašalićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Denis DošenORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Boško SkorićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Eduard MargetićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Joško BulumORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: antoniohanzek0@gmail.com

    Abstract

    **Introduction**: The efficiency of drug-coated balloon (DCB) percutaneous coronary intervention (PCI) has been shown for in-stent restenosis (ISR) and native small-vessel disease, with available data showing similar outcomes in both chronic kidney disease (CKD) and non-CKD patients (1). The aim is to compare the incidence of target lesion restenosis at follow-up (FUP) coronary angiography in patients with and without CKD receiving DCB PCI. **Patients and Methods**: The registry included patients undergoing a DCB PCI at the University Hospital Centre Zagreb from February 2011 to January 2023 (n=652). Patient demographics, comorbidities, pharmacotherapy, as well as data on the initial and FUP coronary angiography/PCI was collected. Chronic kidney disease was defined as estimated glomerular filtration rate < 45 ml/min/1.73m2. A FUP angiography was performed in 49% of patients (n=317), with a median FUP of 6 (interquartile range 3 - 18) months, without difference between groups. **Results**: Data is shown in **Table 1**. The cohort was 75% male, mean age 65 ± 10 years. CKD was present in 9% (n=57) of patients and was associated with a higher incidence of arterial hypertension, diabetes mellitus, atrial fibrillation, as well as peripheral artery disease. The age difference was noted between groups, with CKD patients being older on average. At initial PCI, more CKD patients had multivessel coronary disease, with a higher rate of ISR as the indication for DCB, that was not statistically significant (CKD vs non-CKD: 46% vs 34%, p=0.075). After DCB, no difference was noted between groups in regards to the need for a bail-out PCI (9% VS 6%, P=0.375). FUP was performed in an equal percentage of patients in both groups (48% vs 51%, p=0.769), with no differences seen in the incidence of restenosis (17% vs. 18%, p=0.998), the need for target lesion PCI (17% vs. 13%, p=0.533), or the use of anti-anginal drugs. ### TABLE 1: Comparison between chronic kidney disease (CKD) and non-CKD patients. | | | Patients with chronic kidney disease (n=57) | Patients without chronic kidney disease (n=585) | P -value | | --- | --- | --- | --- | --- | | Initial PCI hospitalization | | | | | | Age, years (mean ± SD) | | 72 ± 9 | 64 ± 10 | <0.001* | | Male sex, n (%) | | 38 (67) | 445 (76) | 0.147 | | History of myocardial infarction, n (%) | | 31 (54) | 246 (42) | 0.073 | | History of PCI, n (%) | | 39 (68) | 347 (59) | 0.180 | | History of CABG, n (%) | | 5 (9) | 21 (4) | 0.071 | | History of stroke or TIA, n (%) | | 7 (12) | 34 (6) | 0.057 | | History of atrial fibrillation, n (%) | | 19 (33) | 61 (10) | <0.001* | | History of peripheral artery disease, n (%) | | 11 (19) | 44 (8) | <0.002* | | Arterial hypertension, n (%) | | 55 (97) | 502 (86) | 0.022* | | Diabetes mellitus, n (%) | | 32 (56) | 190 (33) | <0.001* | | ACS as indication for DCB PCI, n (%) | | 25 (44) | 275 (47) | 0.679 | | Multivessel coronary disease, n (%) | | 39 (70) | 292 (50) | 0.013* | | In-stent restenosis, n (%) | | 25 (46) | 194 (34) | 0.075 | | Bail-out PCI, n (%) | | 5 (9) | 35 (6) | 0.375 | | Follow-up hospitalization | | | | | | Elective procedure, n (%) | | 18 (75) | 244 (84) | 0.261 | | Restenosis of target DCB PCI lesion, n (%) | FUP cohort (n= 317) | 4 (17) | 51 (18) | 0.998 | | Whole cohort (n=645) | 4 (7) | 51 (9) | 0.808 | | [†] SD – standard deviation, PCI – percutaneous coronary intervention, CABG – coronary artery bypass graft, TIA – transient ischemic attack, ACS – acute coronary syndrome, DCB – drug-coated balloon *p<0.05 **Conclusion**: The findings of our single-centre analysis show that patients with CKD do not have a higher risk of target lesion restenosis after DCB PCI, when compared to the non-CKD group, which is in accordance with currently available evidence (2).

    Literature

    1. 1.
      Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, et al. Drug-Coated Balloons for Coronary Artery Disease: Third Report of the International DCB Consensus Group. JACC Cardiovasc Interv. 2020 June 22;13(12):1391–402.DOI
    2. 2.
      Mahfoud F, Farah A, Ohlow MA, Mangner N, Wöhrle J, Möbius-Winkler S, et al. Drug-coated balloons for small coronary artery disease in patients with chronic kidney disease: a pre-specified analysis of the BASKET-SMALL 2 trial. Clin Res Cardiol. 2022 July;111(7):806–15.DOI