Mayo Clin Proc. 2026 Mar 5:S0025-6196(25)16631-7. doi: 10.1016/j.mayocp.2025.11.016. Online ahead of print.
ABSTRACT
OBJECTIVE: To study the long-term cause of death following percutaneous coronary intervention (PCI) in patients from a contemporary data set undergoing dialysis.
PATIENTS AND METHODS: 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.
RESULTS: 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).
CONCLUSION: Patients on dialysis had worse outcomes, including 10-year all-cause and cardiac mortality compared with patients with normal renal function.
PMID:41784590 | DOI:10.1016/j.mayocp.2025.11.016