Abstract

Background:

The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China.

Methods:

This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences.

Results:

Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [n = 278] vs. 43.7% [n = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45–0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs. 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82–2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses.

Conclusion:

This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.

Details

Title
Percutaneous coronary intervention vs. medical therapy in patients on dialysis with coronary artery disease in China
Author
Xie Enmin 1 ; Wu, Yaxin 2 ; Ye Zixiang 3 ; He, Yong 4 ; Zeng Hesong 5 ; Luo Jianfang 6 ; Chen Mulei 7 ; Pang Wenyue 8 ; Xu, Yanmin 9 ; Gao Chuanyu 2 ; Guo Xiaogang 10 ; Cai, Lin 11 ; Ji Qingwei 12 ; Yang, Yining 13 ; Wu, Di 14 ; Yuan Yiqiang 15 ; Wan, Jing 16 ; Ma, Yuliang 17 ; Zhang, Jun 18 ; Du, Zhimin 19 ; Yang, Qing 20 ; Cheng, Jinsong 21 ; Ding Chunhua 22 ; Ma, Xiang 23 ; Yin Chunlin 24 ; Fan Zeyuan 25 ; Tang, Qiang 26 ; Li, Yue 27 ; Sun, Lihua 28 ; Lu, Chengzhi 29 ; Chi Jufang 30 ; Yao Zhuhua 31 ; Gao Yanxiang 32 ; Yu Changan 32 ; Ren Jingyi 32 ; Zheng Jingang 1 

 Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100029, China 
 Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan 450003, China 
 Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China 
 Department of Cardiology, West China Hospital, Chengdu, Sichuan 610041, China 
 Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China 
 Department of Cardiology, Guangdong Provincial People’s Hospital, Guangzhou, Guangdong 510080, China 
 Department of Cardiology, Beijing Chaoyang Hospital, Beijing 100020, China 
 Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 117004, China 
 Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300192, China 
10  Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China 
11  Department of Cardiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan 610014, China 
12  Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China 
13  Department of Cardiology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang 830001, China 
14  Department of Cardiology, Emergency General Hospital, Beijing 100028, China 
15  Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, Henan 450003, China 
16  Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China 
17  Department of Cardiology, Peking University People’s Hospital, Beijing 100044, China 
18  Department of Cardiology, Cangzhou Central Hospital of Tianjin Medical University, Cangzhou, Hebei 061001, China 
19  Department of Cardiology, Dongguan Tungwah Hospital, Dongguan, Guangdong 523015, China 
20  Department of Cardiology, Tianjin Medical University General Hospital, Tianjin 300052, China 
21  Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, China 
22  Department of Cardiology, Aerospace Center Hospital, Beijing100049, China 
23  Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang 830011, China 
24  Department of Cardiology, Xuanwu Hospital, Beijing 100053, China 
25  Department of Cardiology, Civil Aviation General Hospital, Beijing 100123, China 
26  Department of Cardiology, Peking University Shougang Hospital, Beijing 100144, China 
27  Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, China 
28  Department of Cardiology, Fifth Affiliated Hospital of Xinjiang Medical University, Xinjiang 830000, China 
29  Department of Cardiology, First Central Hospital of Tianjin, Tianjin 300190, China 
30  Department of Cardiology, Shaoxing People’s Hospital, Shaoxing, Zhejiang 312099, China 
31  Department of Cardiology, Tianjin Union Medicine Center, Tianjin 300121, China 
32  Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China 
Pages
301-310
Section
Original Article
Publication year
2025
Publication date
Feb 2025
Publisher
Lippincott Williams & Wilkins Ovid Technologies
ISSN
03666999
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3163289563
Copyright
Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.