Impact of left ventricular function on outcomes in patients with chronic kidney disease undergoing percutaneous coronary intervention.

BACKGROUND

Reduced left ventricular ejection fraction (LVEF) is associated with increased morbidity and mortality after percutaneous coronary intervention (PCI). The impact of reduced LVEF among patients with chronic kidney disease (CKD) undergoing PCI remains unclear.

METHODS

We included all patients who underwent PCI at a tertiary-care center, between 2012 and 2023. Patients were divided into those with and without CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) and further stratified by the presence of reduced LVEF (<50%). The primary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI), or target vessel revascularization at 1 year after PCI.

RESULTS

Out of 12,353 patients, 3,199 (25.9%) had CKD of whom 751 (23.5%) had reduced LVEF. In patients with CKD, mean LVEF was 36.7 ± 8.5% and 59.6 ± 4.9% in those with reduced and normal LVEF, respectively (P < .001). Those with reduced vs normal LVEF had a higher prevalence of advanced atherosclerotic disease and comorbidities. There was no significant difference in MACE among CKD patients with reduced vs normal LVEF (HR 1.18, 95% CI 0.90-1.54, P = .23). Nonetheless, those with reduced vs normal LVEF had higher risk of all-cause death (HR 1.85, 95% CI 1.10-3.10, P < .05) and MI (HR 1.78, 95% CI 1.07-2.98, P < .05). Concordantly, non-CKD patients had increased risk of MACE and all-cause death; no significant interaction was found between LVEF and presence of CKD.

CONCLUSIONS

Reduced LVEF may adversely affect outcomes in patients with and without CKD alike.