Percutaneous coronary intervention vs. medical therapy in patients on dialysis with coronary artery disease in China
Abstract. Background:. The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared...
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Wolters Kluwer
2025-02-01
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| Series: | Chinese Medical Journal |
| Online Access: | http://journals.lww.com/10.1097/CM9.0000000000003295 |
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| author | Enmin Xie Yaxin Wu Zixiang Ye Yong He Hesong Zeng Jianfang Luo Mulei Chen Wenyue Pang Yanmin Xu Chuanyu Gao Xiaogang Guo Lin Cai Qingwei Ji Yining Yang Di Wu Yiqiang Yuan Jing Wan Yuliang Ma Jun Zhang Zhimin Du Qing Yang Jinsong Cheng Chunhua Ding Xiang Ma Chunlin Yin Zeyuan Fan Qiang Tang Yue Li Lihua Sun Chengzhi Lu Jufang Chi Zhuhua Yao Yanxiang Gao Changan Yu Jingyi Ren Jingang Zheng Rongman Jia |
| author_facet | Enmin Xie Yaxin Wu Zixiang Ye Yong He Hesong Zeng Jianfang Luo Mulei Chen Wenyue Pang Yanmin Xu Chuanyu Gao Xiaogang Guo Lin Cai Qingwei Ji Yining Yang Di Wu Yiqiang Yuan Jing Wan Yuliang Ma Jun Zhang Zhimin Du Qing Yang Jinsong Cheng Chunhua Ding Xiang Ma Chunlin Yin Zeyuan Fan Qiang Tang Yue Li Lihua Sun Chengzhi Lu Jufang Chi Zhuhua Yao Yanxiang Gao Changan Yu Jingyi Ren Jingang Zheng Rongman Jia |
| author_sort | Enmin Xie |
| collection | DOAJ |
| description | Abstract.
Background:. The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China.
Methods:. This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences.
Results:. Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [n = 278] vs. 43.7% [n = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45–0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs. 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82–2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses.
Conclusion:. This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance. |
| format | Article |
| id | doaj-art-54f9fb807b2f4648b819ace4e3f862ea |
| institution | Kabale University |
| issn | 0366-6999 2542-5641 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wolters Kluwer |
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| series | Chinese Medical Journal |
| spelling | doaj-art-54f9fb807b2f4648b819ace4e3f862ea2025-01-27T06:04:15ZengWolters KluwerChinese Medical Journal0366-69992542-56412025-02-01138330131010.1097/CM9.0000000000003295202502050-00008Percutaneous coronary intervention vs. medical therapy in patients on dialysis with coronary artery disease in ChinaEnmin Xie0Yaxin Wu1Zixiang Ye2Yong He3Hesong Zeng4Jianfang Luo5Mulei Chen6Wenyue Pang7Yanmin Xu8Chuanyu Gao9Xiaogang Guo10Lin Cai11Qingwei Ji12Yining Yang13Di Wu14Yiqiang Yuan15Jing Wan16Yuliang Ma17Jun Zhang18Zhimin Du19Qing Yang20Jinsong Cheng21Chunhua Ding22Xiang Ma23Chunlin Yin24Zeyuan Fan25Qiang Tang26Yue Li27Lihua Sun28Chengzhi Lu29Jufang Chi30Zhuhua Yao31Yanxiang Gao32Changan Yu33Jingyi Ren34Jingang Zheng35Rongman Jia1 Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China3 Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan 450003, China4 Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China5 Department of Cardiology, West China Hospital, Chengdu, Sichuan 610041, China6 Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China7 Department of Cardiology, Guangdong Provincial People’s Hospital, Guangzhou, Guangdong 510080, China8 Department of Cardiology, Beijing Chaoyang Hospital, Beijing 100020, China9 Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 117004, China10 Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300192, China3 Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan 450003, China11 Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China12 Department of Cardiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan 610014, China13 Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China14 Department of Cardiology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang 830001, China15 Department of Cardiology, Emergency General Hospital, Beijing 100028, China16 Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, Henan 450003, China17 Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China18 Department of Cardiology, Peking University People’s Hospital, Beijing 100044, China19 Department of Cardiology, Cangzhou Central Hospital of Tianjin Medical University, Cangzhou, Hebei 061001, China20 Department of Cardiology, Dongguan Tungwah Hospital, Dongguan, Guangdong 523015, China21 Department of Cardiology, Tianjin Medical University General Hospital, Tianjin 300052, China22 Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, China23 Department of Cardiology, Aerospace Center Hospital, Beijing100049, China24 Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang 830011, China25 Department of Cardiology, Xuanwu Hospital, Beijing 100053, China26 Department of Cardiology, Civil Aviation General Hospital, Beijing 100123, China27 Department of Cardiology, Peking University Shougang Hospital, Beijing 100144, China28 Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, China29 Department of Cardiology, Fifth Affiliated Hospital of Xinjiang Medical University, Xinjiang 830000, China30 Department of Cardiology, First Central Hospital of Tianjin, Tianjin 300190, China31 Department of Cardiology, Shaoxing People’s Hospital, Shaoxing, Zhejiang 312099, China32 Department of Cardiology, Tianjin Union Medicine Center, Tianjin 300121, China1 Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China1 Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China1 Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China1 Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, ChinaAbstract. Background:. The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. Methods:. This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. Results:. Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [n = 278] vs. 43.7% [n = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45–0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs. 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82–2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. Conclusion:. This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.http://journals.lww.com/10.1097/CM9.0000000000003295 |
| spellingShingle | Enmin Xie Yaxin Wu Zixiang Ye Yong He Hesong Zeng Jianfang Luo Mulei Chen Wenyue Pang Yanmin Xu Chuanyu Gao Xiaogang Guo Lin Cai Qingwei Ji Yining Yang Di Wu Yiqiang Yuan Jing Wan Yuliang Ma Jun Zhang Zhimin Du Qing Yang Jinsong Cheng Chunhua Ding Xiang Ma Chunlin Yin Zeyuan Fan Qiang Tang Yue Li Lihua Sun Chengzhi Lu Jufang Chi Zhuhua Yao Yanxiang Gao Changan Yu Jingyi Ren Jingang Zheng Rongman Jia Percutaneous coronary intervention vs. medical therapy in patients on dialysis with coronary artery disease in China Chinese Medical Journal |
| title | Percutaneous coronary intervention vs. medical therapy in patients on dialysis with coronary artery disease in China |
| title_full | Percutaneous coronary intervention vs. medical therapy in patients on dialysis with coronary artery disease in China |
| title_fullStr | Percutaneous coronary intervention vs. medical therapy in patients on dialysis with coronary artery disease in China |
| title_full_unstemmed | Percutaneous coronary intervention vs. medical therapy in patients on dialysis with coronary artery disease in China |
| title_short | Percutaneous coronary intervention vs. medical therapy in patients on dialysis with coronary artery disease in China |
| title_sort | percutaneous coronary intervention vs medical therapy in patients on dialysis with coronary artery disease in china |
| url | http://journals.lww.com/10.1097/CM9.0000000000003295 |
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