SPC365

Percutaneous coronary intervention in elderly patients with chronic kidney disease and non-ST segment elevation acute coronary syndrome - Is it worth it?

Session: Posters (Sessão 6 - Écran 7) - Intervenção Coronária e Estrutural 4 - Doença coronária
Speaker: Alexandra Briosa

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Alexandra Briosa; Rita Cale; Mariana Martinho; João Santos; Barbara Ferreira; Diogo Cunha; Ana Rita Pereira; Ana Marques; Sofia Alegria; Daniel Sebaiti; Ana Catarina Gomes; Gonçalo Morgado; Cristina Martins; Helder Pereira

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><em><span style="font-size:9pt">Introduction:</span></em></strong><span style="font-size:9pt"> The ESC guidelines recommend appropriate revascularization in patients (pts) with chronic kidney disease (CKD) irrespective of age. However, elderly pts are usually underrepresented in the available data on percutaneous coronary intervention (PCI). The decision on whether to perform PCI in elderly pts with CKD and acute coronary syndrome&nbsp;is usually at the discretion of the cardiology team. </span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><em><span style="font-size:9pt">Aim:</span></em></strong><span style="font-size:9pt">&nbsp;Evaluate the impact of PCI vs conservative approach (CA)&nbsp;in elderly pts&nbsp;with CKD enrolled in the Portuguese National Registry of Acute Coronary Syndromes, admitted with unstable angina(UA)&nbsp;and non-ST segment elevation myocardial infarction (NSTEMI). Determine impact of CKD in in-hospital and long-term outcomes, including MACE (myocardial infarction, stroke and death).</span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:9pt"><strong><em>Method: </em></strong>Included elderly pts (&gt; 80 years) admitted with UA and NSTEMI, from 2010 until today. The pts were divided in 3 groups: Group 1 - eGFR&nbsp;&ge; 60 ml/min/1.73m<sup>2</sup>; Group 2- between 30 and 59 ml/min/1.73m<sup>2</sup> and Group 3 -&nbsp;&lt; 30 ml/min/1.73m<sup>2</sup>. Pts with STEMI and cardiogenic shock were excluded.</span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:9pt">Results: </span></strong><span style="font-size:9pt">A t</span><span style="font-size:9pt">otal of 2443 pts, of which&nbsp;921 (37,7%) were submitted to PCI. 50.2% of pts were from group 1, 38.5% from group 2 and 11.3% from group 3.&nbsp;</span></span></span></span><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:9pt">Regarding overall population, pts submitted to PCI were mainly male (60,4%) with&nbsp;mean age of 84&plusmn;3 years. They had previous history of PCI (21,6% vs 15,1% p&lt;0.001),&nbsp;less history of heart failure (HF), stroke or dementia (8,5% vs 16,5%; 8,1&nbsp;vs 13.3% and 2,1 vs 5,9%, p&lt;0.001 respectively). At presentation they had more angina (88,8% vs 81,2% p&lt;0.001), lower NT-proBNP levels (387 vs 561 p&lt; 0.001) and were more frequently in KK class I (75,6% vs 70,2% p=0.004). Concerning outcomes, they developed less HF (21% vs 27%, p&lt;0.001) and less MACE (5,7% vs 9,1% p=0.003). Pts in the group 3 were less submitted to PCI (27,5% vs 38,2% vs 39,6% p&lt; 0.001) and had more MACE and death when comparing to group 2 and 1 (16,1% vs 8,7% vs 5,3% and 10,5% vs 5,5% vs 2,6% p&lt;0.001 respectively). </span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:9pt">Comparing PCI&nbsp;vs CA, there was no difference in intrahospitalar outcomes between both strategies in group 3. The same was not true for pts in groups 1 and 2, in which PCI seemed to favor overall outcomes (p=0.001 and p=0.015). </span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:9pt">&nbsp;Predictors of intrahospitalar death&nbsp;were: age (OR 1.068 p=0.010), dementia (OR 2,376 p=0.015), KK class &gt; 1 (OR 2,243, p&lt;0.001), atrial fibrilhation (OR 1.605, p= 0.046),&nbsp;PCI (OR 0.309, p&lt;0.001), eGFR &lt;30 (OR 3.51, p&lt;0.001) and PCI in pts with eGFR &lt;30 (OR 2.923, p=0.019). </span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:9pt">Interestingly, survival analysis showed that pts submitted to PCI in all 3 groups had a longer 1- year survival (p&lt;0.001, p&lt;0.001 and p&lt; 0.004). </span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:9pt">Conclusions: </span></strong><span style="font-size:9pt">The decision of performing PCI in elderly pts with CKD should be individualized, considering its beneficial risks. In our study, more specifically in group 3, the performance of PCI is associated with a higher in-hospital mortality, however, after surviving hospitalization, these pts&nbsp;seem to have a benefit in 1 year survival.</span></span></span></span></p>