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Impact of chronic kidney disease on the long-term prognosis of patients with atrial fibrillation undergoing coronary stenting

Yu-Bin Wang, Juan Ma, Jian-Yong Zheng, Bo-Yang Zhang, Peng-Fei Liu, Nan-Nan Wang, Guang-Yuan Song, Jian-Min Chu, Cheng-Jun Guo, Tian-Chang Li, Yong-Jian Wu

Background: The effect of Chronic Kidney Disease (CKD) on the long-term prognosis of patients with Atrial Fibrillation (AF) undergoing coronary stenting was less studied.

Methods: We enrolled 2,511 patients with non-valvular AF undergoing coronary stenting between January 2010 and June 2015 from 12 hospitals in Beijing, China.

Results: 22.9% had CKD (creatinine clearance<60 ml/min). Compared to those with preserved renal function, patients with CKD were older, and had the higher prevalence of women, hypertension, previous ischemic stroke, cardiac dysfunction, and anemia. All patients were treated with drug-eluting stents. Dual antiplatelet therapy was the dominant antithrombotic strategy in both groups (96.0% vs. 93.9%, P=0.054). The follow-up duration was 39.5 ± 18.6 months. Complete follow-up data was obtained for 95.3% of this cohort. CKD group had higher incidences of death (19.0% vs. 6.9%, P<0.001), ischemic stroke (5.5% vs. 3.3%, P=0.020), MACCE (a composite of all-cause death, non-fatal myocardial infarction, target vessel revascularization, ischemic stroke and arterial thromboembolism, 28.2% vs. 14.7%, P<0.001) and Bleeding Academic Research Consortium (BARC) ≥ grade 3 (2.4% vs. 0.8%, P=0.003). No significant difference was noted with regard to myocardial infarction and target vessel revascularization. Cox multivariate regression identified CKD as an independent risk factor for allcause death (Hazard ratio (HR): 1.85, 95% CI: 1.37-2.50), MACCE (HR: 1.56, 95% CI: 1.25-1.96) and BARC ≥ 3 bleeding (HR: 3.14, 95% CI: 1.49-6.61), but not for ischemic stroke (HR: 1.10, 95% CI: 0.67-1.79).

Conclusion: CKD was independently associated with poor long-term prognosis except for ischemic stroke in patients with AF and coronary stenting.