Differential Impact of Chronic Kidney Disease Stages on the Survival Benefit of Percutaneous Coronary Intervention: A Large Real-world Cohort Study

Chronic kidney disease (CKD) is prevalent among patients with coronary artery disease (CAD) and exacerbates myocardial ischemia. However, the survival benefit of percutaneous coronary intervention (PCI) across different stages of CKD remains controversial. CAD patients (n = 17,418) with CKD (mean age, 69.5 ± 9.9 years; 70.9% male) were included in the Cardiorenal Improvement II cohort from 2007 to 2020. Patients were grouped by PCI or medical treatment and further categorized by stages 3a-5 CKD. Multivariable Cox regression was performed to investigate the associations of cardiovascular- and all-cause mortality with PCI and CKD stage, and to compare predictors of outcomes in patients stratified by advanced CKD. During a median follow-up of 4.2 years, 4605 (26.4%) participants died. Compared with medical treatment, PCI was not associated with improved survival benefit among patients with stage 3b-5 CKD (all P > .05). Among patients with advanced CKD, hypertension, hyperfibrinogenemia and moderate-severe malnutrition were more significantly associated with increased cardiovascular mortality with relatively high attributable risk. PCI was not associated with a survival advantage among patients with advanced CKD. Hypertension, hyperfibrinogenemia and malnutrition may contribute to poor prognosis in patients with advanced kidney disease.