Chest. 2008 Nov 18. [Epub ahead of print]

Impact of Chronic Kidney Disease on Major Bleeding Complications and Mortality in Patients With Indication for Oral Anticoagulation Undergoing Coronary Stenting.

Manzano-Fernández S, Marín F, Pastor-Pérez FJ, Caro C, Cambronero F, Lacunza J, Pinar E, Pascual-Figal DA, Valdés M, Lip GY.

From the Department of Cardiology (Drs. Manzano-Fernández, Marín, Pastor-Pérez, Caro, Cambronero, Lacunza, Pinar, Pascual-Figal, and Valdés), University Hospital Virgen de la Arrixaca, Murcia, Spain; and University Department of Medicine (Dr. Lip), City Hospital, Birmingham, UK.

Background Patients with indications for oral anticoagulation (OAC) undergoing percutaneous coronary artery stenting (PCI-S) represent a high-risk population for major bleeding complications. Chronic kidney disease (CKD) is also associated with poor outcome after PCI-S. Limited data are available regarding the impact of CKD on the frequency of major bleeding and mortality in this population. Methods We investigated the influence of CKD on major bleeding and all-cause mortality in patients with indication for OAC who undergo PCI-S. Patients were grouped according to calculated creatinine clearance (CrCl): CrCl >/= 60 mL/min, (n = 98) and CrCl < 60 mL/min, (n = 68). Major bleeding and major adverse vascular events (all-cause mortality, myocardial infarction, repeat revascularization, stent thrombosis, or stroke) were collected during follow-up. Results We analyzed 166 consecutive patients with indication(s) for OAC (77% men; mean age, 71 years; range, 66 to 76 years) after undergoing PCI-S. CKD was associated with higher risk for major bleeding (hazard ratio [HR], 3.44; 95% confidence interval [CI], 1.50 to 7.93; p = 0.004) and all-cause mortality (HR, 3.50; 95% CI, 1.53 to 7.99; p = 0.003). In multivariate analyses, age >/= 75 years (HR, 2.75; 95% CI, 1.15 to 6.56; p = 0.023), CKD (HR, 2.59; 95% CI, 1.00 to 6.95; p = 0.049), anemia (HR, 2.36; 95% CI, 1.00 to 5.54; p = 0.049), and triple antithrombotic therapy (HR, 3.29; 95% CI, 1.23 to 8.84; p = 0.018) were independent predictors for major bleeding, whereas age >/= 75 years (HR, 2.38; 95% CI, 1.03 to 5.59; p = 0.046) and CKD (HR, 2.44; 95% CI, 1.03 to 5.82; p = 0.044) were predictors for all-cause mortality. Conclusion In this high-risk population, CKD is independently associated with increased major bleeding and all-cause mortality following PCI-S.

Impact of Chronic Kidney Disease on Major Bleeding...[Chest. 2008] - PubMed Result