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CHRONIC KIDNEY DISEASE IS ASSOCIATED WITH WORSE CLINICAL OUTCOMES FOLLOWING CAROTID ARTERY STENTING
J Saw, DL Bhatt, HS Gurm, RB Fathi, A Abou-Chebl, C Bajzer,
JS Yadav
Cleveland, Ohio, USA
BACKGROUND: It is unknown if chronic kidney disease (CKD) is associated with worse clinical outcomes following carotid artery stenting (CAS).
METHODS: Patients who underwent CAS at the Cleveland Clinic from February 1998 to October 2003 were followed in a prospective registry. We excluded patients who did not have baseline serum creatinine and weight recorded. All patients received aspirin, a thienopyridine, and intravenous unfractionated heparin. Patients were grouped according to the presence of CKD (glomerular filtration rate <60 ml/min/1.73 m2) or not, and also according to creatinine clearance (CrCL) quartiles. The incidence of death, stroke, or myocardial infarctions (MI) at 7 days and 6 months were assessed. Cox regression analysis was performed to identify univariate and multivariate predictors of 6-month combined events.
RESULTS: Of 641 patients who underwent CAS, 581 had baseline creatinine and weight recorded. The presence of CKD was associated with a higher combined (death, stroke, or MI) event-rate at 7 d (6.8% vs. 2.7%, p=0.023) and 6 months (14.7% vs. 5.6%, p<0.001), higher 6-month mortality (8.4% vs. 3.4%, p=0.015), and higher 6-month stroke incidence (4.2% vs. 0.8%, p=0.009) compared with those without CKD. The 6-month Kaplan-Meier event-free (death, stroke, or MI) survival was significantly higher among those without CKD versus those with CKD (p<0.001). Patients in the highest CrCL quartile (4th quartile) had a significantly lower combined event-rate at both 7 d (1.4% vs. 6.2%, p=0.049) and 6 months (4.1% vs. 14.5%, p=0.004) compared with those in the lowest CrCL quartile (1st quartile). The Kaplan-Meier event-free survival curve also shows a significant relationship between quartiles of CrCL and 6-month combined event-rate (p=0.017 for comparison of all 4 groups). Forward multivariate Cox regression analysis identified CKD and diabetes as independent predictors of 6-month combined event-rate.
CONCLUSIONS: CKD is associated with higher periprocedural and 6-month death, stroke, or MI following CAS. This risk is proportional to worsening creatinine clearance. Both CKD and diabetes are independent predictors of adverse 6-month events following CAS.
DNC