The management of non‐culprit vessel(s) in patients with unstable angina/non‐ST elevation myocardial infarction and chronic kidney dysfunction

Abstract

AbstractBackground and AimsThe clinical effects of multivessel interventions in patients with unstable angina/non‐ST‐segment elevation myocardial infarction (UA/NSTEMI), multivessel disease (MVD) and chronic kidney disease (CKD) remain uncertain. This study aimed to investigate the safety and effectiveness of intervention in non‐culprit lession(s) among this cohort.MethodsWe consecutively included patients diagnosed with UA/NSTEMI, MVD and CKD between January 2008 and December 2018 at our centre. After successful percutaneous coronary intervention (PCI), we compared 48‐month overall mortality between those undergoing multivessel PCI (MV‐PCI) through a single‐procedure or staged‐procedure approach and culprit vessel‐only PCI (CV‐PCI) after 1:1 propensity score matching. We conducted stratified analyses and tests for interaction to investigate the modifying effects of critical covariates. Additionally, we recorded the incidence of contrast‐induced nephropathy (CIN) to assess the perioperative safety of the two treatment strategies.ResultsOf the 749 eligible patients, 271 pairs were successfully matched. Those undergoing MV‐PCI had reduced all‐cause mortality (hazard ratio (HR): 0.67, 95% confidence interval (CI): 0.48–0.67). Subgroup analysis showed that those with advanced CKD (estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2) could not benefit from MV‐PCI (P = 0.250), and the survival advantage also tended to diminish in diabetes (P interaction < 0.01; HR = 0.95, 95% CI = 0.65–1.45). Although the staged‐procedure approach (N = 157) failed to bring additional survival benefits compared to single‐procedure MV‐PCI (N = 290) (P = 0.460), it showed a tendency to decrease the death risk. CIN risks in MV‐PCI and CV‐PCI groups were not significantly different (risk ratio = 1.60, 95% CI = 0.94–2.73).ConclusionAmong patients with UA/NSTEMI and non‐diabetic CKD and an eGFR > 30 mL/min/1.73 m2, MV‐PCI was associated with a reduced risk of long‐term death but did not increase the incidence of CIN during the management of MVD compared to CV‐PCI. And staged procedures might be a preferable option over single‐procedure MV‐PCI.