Ten-Year Clinical Outcomes and Cause of Death in Patients on Dialysis Undergoing Percutaneous Coronary Intervention: A Retrospective Mayo Clinic PCI Registry Analysis.

Abstract

To study the long-term cause of death following percutaneous coronary intervention (PCI) in patients from a contemporary data set undergoing dialysis. We evaluated successive patients who underwent PCI from September 30, 2009, to October 31, 2023, and categorized them according to the MDRD (Modification of Diet in Renal Disease) equation into group 1 (normal renal function), group 2 (mild-moderate renal dysfunction; chronic kidney disease stage 1 to 3a), group 3 (moderate to severe renal disease; chronic kidney disease stage 3b to 5), and group 4 (patients undergoing dialysis). Multivariable Cox proportional hazards models were fit to examine the effect of dialysis on 10-year all-cause/cardiac mortality and major adverse cardiac events. Cause of death was determined via telephone interviews, medical records, autopsy reports, and death certificates. Overall, 15,403 patients underwent PCI during our study period, 369 of whom were receiving dialysis and 1659 who had moderate to severe renal dysfunction. Group 4 patients were younger (median age group 4: 66 years vs group 1-3: 69 years) with a higher comorbid burden (Charlson Comorbidity Index score for group 4 was 8 vs 4 for group 1). After multivariable adjustment, group 4 as compared with group 1 had the worst all-cause mortality (hazard ratio [HR], 3.84; 95% CI, 3.16 to 4.66), cardiac mortality (HR, 4.95; 95% CI, 3.53 to 6.95), major adverse cardiac events (HR, 2.32; 95% CI, 1.99 to 2.70), repeat revascularization (HR, 1.29; 95% CI, 0.92 to 1.82), and recurrent hospitalization (HR, 2.14; 95% CI, 1.86 to 2.45). Long-term cause of death was dominantly noncardiovascular. However, cardiovascular mortality accounted for 38.9% of deaths in group 4 (65 of 167) as compared with 24.3% in group 1 (82 of 338) (P<.001). Patients on dialysis had worse outcomes, including 10-year all-cause and cardiac mortality compared with patients with normal renal function.