Impact of Chronic Kidney Disease on Clinical Outcomes after Percutaneous Coronary Intervention with Drug-Coated Balloons

Impact of Chronic Kidney Disease on Clinical Outcomes after Percutaneous Coronary Intervention with Drug-Coated Balloons | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Impact of Chronic Kidney Disease on Clinical Outcomes after Percutaneous Coronary Intervention with Drug-Coated Balloons View ORCID Profile Tetsuya Takahashi , View ORCID Profile Tetsu Watanabe , Mashu Toyoshima , Wataru Katawaki , Taku Toshima , Yu Kumagai , Tamon Yamanaka , Masafumi Watanabe doi: https://doi.org/10.1101/2024.06.20.24309055 Tetsuya Takahashi 1 The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital , Miyagi, Japan , MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Tetsuya Takahashi For correspondence: tewatana{at}med.id.yamagata-u.ac.jp Tetsu Watanabe 2 The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine , Yamagata, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Tetsu Watanabe Mashu Toyoshima 1 The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital , Miyagi, Japan , MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Wataru Katawaki 1 The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital , Miyagi, Japan , MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Taku Toshima 1 The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital , Miyagi, Japan , MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Yu Kumagai 1 The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital , Miyagi, Japan , MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Tamon Yamanaka 1 The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital , Miyagi, Japan , MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Masafumi Watanabe 2 The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine , Yamagata, Japan MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Background Drug coated balloon (DCB) is an emerging treatment technology for percutaneous coronary intervention (PCI). However, the prognostic factors of PCI with DCB remain fully determined. Chronic kidney disease (CKD) is an independent predictor of adverse outcomes in patients with coronary artery disease (CAD) who underwent PCI. The aim of the present study was to clarify the impact of CKD on prognosis in CAD patients who underwent PCI with DCB. Methods We enrolled 252 consecutive patients with CAD who underwent PCI with DCB from 2015 to 2023. The endpoints of this study were composite events including all-cause death, myocardial infarction, target vessel revascularization, stroke, and major bleeding. Results The prevalence rate of CKD was 48%. Patients with CKD were older and had higher prevalence of hypertension and diabetes mellitus than those without. Kaplan-Meier analysis revealed a significantly higher composite event rate in patients with CKD (log-rank test, P = 0.003). In the multivariate Cox proportional hazards analysis, CKD was independently associated with composite events after adjusting for confounding factors (adjusted hazard ratio 1.920, 95% confidence intervals 1.154-3.197, P = 0.012), mainly driven by all-cause deaths. Conclusion CKD was associated with unfavorable outcomes in CAD patients who underwent PCI with DCB. Introduction Drug-coated balloons (DCBs) have been established as a novel treatment option of percutaneous coronary intervention (PCI) 1 , 2 , 3 . The previous study has demonstrated that DCB treatment has been noninferior compared to conventional drug uncoated balloon angioplasty for the treatment of in-stent restenosis 1 . DCB has also shown comparable clinical outcomes compared to drug eluting stent (DES) in patients with small-vessel coronary artery disease (CAD) 2 , 3 . Furthermore, recent studies have demonstrated the favorable clinical effect of DCB in CAD patients with multivessel, de novo large vessel, and long diffuse vessel diseases 4 , 5 , 6 . However, the prognostic impact of DCB on clinical outcomes in patients with CAD has not been adequately addressed although there are several favorable clinical data in the setting of comparison between DCB and DES. Chronic kidney disease (CKD) is reportedly observed in approximately 10% of the general population 7 . The prevalence rate of CKD in patients with CAD has been increasing with aging population 8 , 9 . The previous study demonstrated that CAD severity was associated with the CKD 10 . The presence of CKD has been associated with unfavorable prognosis in patients with CAD 11 . Therefore, CKD has been recognized as one of the important predictor for cardiovascular prognosis in the era of DES 12 . However, the association between CKD and DCB remains unclear. The aim of the present study was to clarify the prognostic impact of CKD on prognosis in CAD patients who underwent PCI using DCB. Methods Study population This is a prospective, single-center, observational study. We enrolled 288 consecutive CAD patients who underwent PCI with DCB between January 2015 and December 2023. We excluded 36 patients with missing clinical data after PCI. The remaining 252 patients were included in this study. Acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) were diagnosed based on the current guidelines, respectively 13 , 14 . Angiographical coronary stenosis was assessed according to the American College of Cardiology / American Heart Association / Society for Cardiovascular Angiography and Interventions (ACC / AHA / SCAI) 15 . Significant coronary stenosis was defined as a visually estimated diameter stenosis severity of ≥ 70% for non-left main disease and ≥ 50% for left main disease. PCI was performed based on contemporary standard techniques and current guidelines 16 , 17 , 18 . Demographic and clinical data including age, sex, smoking, atrial fibrillation (AF), family history of CAD, previous myocardial infarction (MI), previous PCI, previous coronary artery bypass graft (CABG), previous stroke, chronic heart failure (CHF), clinical presentation of peripheral artery disease (PAD), abdominal aortic aneurysm (AAA), chronic obstructive pulmonary disease (COPD), malignant tumor, ACS and CCS, and medications at discharge were collected from patients’ medical records and through interviews. Body mass index (BMI) was calculated based on the patient’s weight and height measured during hospitalization. Diagnoses of hypertension, diabetes mellitus, and dyslipidemia were established based on medical records or a history of related medical therapy. Transthoracic echocardiography was performed by physicians. Informed consent was obtained from all patients prior to participation. All procedures were performed in accordance with the Declaration of Helsinki. The study was approved by the Institutional Ethics Committee of Yamagata University School of Medicine (Yamagata University, 2020-344). Assessment of renal function The eGFR was calculated using the Modification of Diet in Renal Disease equation with the Japanese coefficient 19 . Venous blood samples were obtained early in the morning, within 24 h after admission. Serum creatinine levels were measured using routine laboratory methods. Chronic kidney disease (CKD) was defined as reduced eGFR (< 60 mL/min/1.73m 2 ) according to Kidney Disease Outcomes Quality Initiative clinical guidelines 20 . Endpoints and follow-up Patients were prospectively followed up for a median duration of 492 days (interquartile range 248 -1532 days). Clinical follow-up data were obtained from outpatient record reviews and telephone interviews. The primary endpoint of the present study was composite events including all-cause death, myocardial infarction, target vessel revascularization, stroke, and major bleeding (Bleeding Academic Research Consortium [BARC] type 3-5) 21 . The secondary endpoints were each component of the primary endpoint. Target vessel revascularization is defined as any repeat PCI or surgery with CABG of the target lesion for ischemic symptoms and events. Statistical analysis The normality of continuous variables was assessed using the Shapiro-Wilk test. Continuous data are expressed as mean ± standard deviation (SD), and skewed data are presented as medians with interquartile ranges. Unpaired Student’s t -test and Chi-squared test were performed to compare continuous and categorical variables, respectively. The Mann-Whitney U -test was performed for skewed data. Univariate and multivariate analyses with Cox proportional hazards regression were used to determine significant predictors of clinical events. Predictors that were significant in the univariate analysis were included in the multivariate analysis. Cumulative overall and event-free survival rates were computed using the Kaplan-Meier method and compared using the log-rank test. Statistical significance was set at P < 0.05. All statistical analyses were performed using R studio version 2023. 12. 1 + 402. Results Baseline Characteristics The baseline characteristics of the 252 patients who underwent PCI with DCB are shown in Table 1 . The mean age was 68.8 ± 11.9 years, and there were 204 men (81%). Hypertension, dyslipidemia, diabetes mellitus, smoking, and AF were identified in 208 (83%), 142 (56%), 116 (46%), 172 (68%), and 39 (15%), respectively. Family history of CAD, previous MI, previous PCI, previous CABG, previous stroke, CHF, PAD, AAA, COPD, and malignant tumor were identified in 27 (11%), 58 (23%), 96 (38%), 10 (4%), 32 (13%), 61 (24%), 20 (8%), 14 (6%), 18 (7%), and 36 (14%), respectively. The clinical presentations of ACS were observed as ST elevation MI (STEMI) in 30 (12%) patients, non-STEMI (NSTEMI) in 54 (21%) patients, and unstable angina in 14 (6%) patients. There were 154 (61%) patients with CCS. Three vessel disease and left main disease were identified in 35 (14%) and 11 (4%) patients, respectively. The prevalence of chronic total occlusion (CTO) was 37 (15%). Sixty patients were treated in combination with DES. The mean left ventricular ejection fraction was 54.1 ± 13.5%. View this table: View inline View popup Table 1. Baseline clinical Characteristics Patients were divided into two groups according to the prevalence of CKD. Patients with CKD were significantly older and more women than those without CKD. The prevalence of hypertension, diabetes mellitus, previous PCI, previous CABG, previous stroke, and CHF were significantly higher in patients with CKD than in those without CKD. Patients with CKD had lower prevalence rates of smoking and family history of CAD. CCS, three vessel diseases, and CTO were more likely observed in patients with CKD than in those without CKD. LVEF was significantly lower in patients with CKD than in those without CKD. Patients with CKD took more β blockers than those without CKD. There were no significant differences in the other clinical factors between the two groups ( Table 1 ). Association between CKD and Clinical Outcomes During the follow-up period, there were 70 composite clinical events including 19 all-cause deaths, 12 MI, 34 target vessel revascularization, 4 stroke, and 1 bleeding. The Kaplan-Meier analysis demonstrated that composite clinical events were higher in patients with CKD who underwent PCI with DCB than in those without CKD (log-rank test, P = 0.003) ( Figure 1 ). Download figure Open in new tab Fig 1. Cumulative incidence of composite events according to CKD status. Kaplan-Meier analysis demonstrated a significantly higher composite event rate in patients with CKD (log-rank test, P = 0.003). CKD, chronic kidney disease. In the univariate Cox proportional hazard analysis, CKD and LVEF were significantly associated with the composite events. Multivariate Cox proportional hazard analysis showed that CKD was independently associated with the composite events after adjusting for LVEF (hazard ratios, 1.920; 95% confidence intervals, 1.154-3.197; P = 0.012) ( Table 2 ). View this table: View inline View popup Table 2. Univariate and multivariate Cox proportional hazard analyses for composite events The higher composite event risk was mainly driven by an increased risk of all-cause death ( Figure 2 and Table 3 ). Download figure Open in new tab Download figure Open in new tab Download figure Open in new tab Fig 2. Cumulative incidence of (A) all-cause death, (B) any myocardial infarction, (C) target vessel revascularization, (D) stroke, and (E) bleeding according to CKD status. Kaplan-Meier analysis demonstrated a significantly higher rate of all-cause death in patients with CKD (log-rank test, P = 0.002). No differences in term of myocardial infarction, target vessel revascularization, strike, and bleeding were observed. CKD, chronic kidney disease. View this table: View inline View popup Download powerpoint Table 3. Comparison of clinical outcomes according to CKD status Further, the patients were divided into the five groups according to the CKD stages classified by eGFR (G1, ≥ 90 mL/min/1.73m 2 ; G2, 60 – 89 mL/min/1.73m 2 ; G3, 30 – 59 mL/min/1.73m 2 ; G4, 15 – 29 mL/min/1.73m 2 ; G5, < 15 mL/min/1.73m 2 ) 20 . Kaplan-Meier analysis revealed that composite events were increased with advancing CKD stages (log-rank test, P < 0.0001) (Supplemental Figure 1). Discussion In the present study, (1) Kaplan-Meier analysis demonstrated a significantly higher event rate in patients with CKD than in those without; and (2) multivariate Cox hazard analysis revealed that CKD was significantly associated with poor clinical outcomes in CAD patients who underwent PCI with DCB, driven by higher all-cause mortality. Recently, outcomes of PCI have been dramatically improved since various technologies of interventional cardiology have been developed. Especially, the evolution of DES and procedural techniques, and use of intravascular imaging have made a great contribution to improvement of outcomes of PCI 22 . Furthermore, optimal short duration of dual antiplatelet therapy (DAPT) after PCI has succeeded in favorable prognosis 23 . However, there are still residual risks of PCI such as stent-related adverse events in late phase after PCI even in the era of contemporary DES. A recent study demonstrated that very-late stent-related events occurred in 1 to 5 years after PCI regardless of the type of stents, and the rate of events was about 2% per year with no plaque evident 24 . Contemporary stent technologies have not succeeded in conquest of this ongoing very-late stent-related event risks 24 . Stent under-expansion, malaposition, uncovered stent strut, hypersensitivity reactions, stent fracture, and neoatherosclerosis have been reportedly associated with very-late stent-related events 25 . Therefore, a treatment strategy that leaves nothing in coronary artery has been needed. DCB is a novel technology of PCI and a well established treatment option for contemporary PCI. DCB directly releases antiproliferative drugs into the vessel wall of coronary artery, which leads to the reduction of the untoward effects associated with polymer-based stent technologies 26 . In the clinical setting of coronary in-stent restenosis, treatment with DCB significantly lowered the incidence of adverse events and recurrent in-stent restenosis compared to drug uncoated balloon 1 . For the treatment of small native coronary arteries, DCB also showed non-inferior event rates compared to DES with respect to major adverse cardiovascular events (MACE) for up to 3 years 2 , 3 . Recently, DCB treatment in combination with DES in CAD patients with multivessel diseases significantly reduced MACE at 2 years 4 . Furthermore, recent study have demonstrated that DCB has a potential to improve the cardiovascular outcomes compared to DES even in de novo large coronary arteries 5 . Thus, DCB has various favorable impacts on clinical outcomes in CAD patients who underwent PCI in the era of contemporary DES. However, the prognostic factors of DCB on clinical outcomes in CAD patients who underwent PCI have not been fully described. Further, the favorable clinical evidences about DCB are almost in the setting of comparison between DCB and DES as described above 1 , 2 , 3 , 4 , 5 . In the present study, we demonstrated that CKD was associated with poor clinical outcomes in CAD patients who underwent PCI with DCB. The prevalence rate of CKD in patients with CAD who underwent PCI has been increasing due to the aging population 8 . CAD patients with CKD showed worse clinical outcomes than those with preserved renal function 11 . A recent study demonstrated that angiographic complete revascularization using DES led to favorable prognosis in CAD patients with CKD 27 . However, there are few data about the prognostic impact of CKD on PCI with DCB. The subgroup analyses of the BASKET-SMALL 2 demonstrated that the clinical outcomes were not different between DCB and DES in patients of CKD 2 . The present study revealed the association between the presence of CKD and unfavorable prognosis in CAD patients who underwent PCI with DCB. The pathophysiological role of CKD on the poor prognosis of CAD patients who underwent PCI with DCB has not been fully addressed. In the present study, the proportion of severe CAD status such as 3 vessel disease and CTO was significantly higher in patients with CKD than in those without. The presence of CKD was reported to be associated with the risk of increased coronary lesion complexity in patients with CAD 10 . In CAD patients who underwent PCI with DCB, the presence of CKD might affect the progression of CAD, which leads to poor clinical outcomes. In the present study, the poor prognosis in CKD patients was mainly driven by an increased risk of all-cause death. The previous study of PCI with DES, the all-cause mortality in CKD patients was about 10% 27 , which was consistent with the results of this study. The incident any MI was also higher in patients with CAD although it did not reach statistical significance. This result suggested that the presence of CKD may accelerate atherosclerotic lesion progression and leads to unfavorable prognosis after PCI with DCB. Study limitations This study has several limitations. First, this was a single-center study with a relatively small sample size. Large study population is needed to further clarify prognostic factor in patients with CAD who underwent PCI with DCB, although the sample sizes of recent studies about DCB were relatively small 45 . Second, there were not detailed data of procedure of PCI such as length and diameter of DCBs, length of culprit lesion, and contrast volume because the present study did not focus on PCI procedure. Since the presence of CKD has been reported to be associated with the progression of atherosclerosis 10 , the PCI procedure might be different between 2 groups with and without CKD, which might affect clinical outcomes in the present study. Third, the data of complete revascularization was missing in the present study. The previous study demonstrated that complete revascularization was associated with favorable prognosis in CAD patients with CKD who underwent PCI with DES 27 . There is a possibility that the presence of complete revascularization might affect the results in the present study. Forth, we did not analyze the data of intracoronary imaging, although the usage rate of intracoronary imaging devices was 98% in the present study. The detailed data of intracoronary imaging devices might provide important information of the role of CKD on unfavorable prognosis in CAD patients who underwent PCI with DCB. Fifth, the pathological mechanism of CKD in patients who underwent PCI with DCB was unclear. Vascular calcification and inflammation were reportedly associated with vascular disease in CKD patients 28 . Further studies are required to clarify the extent of these limitations. Conclusions CKD was associated with unfavorable outcomes in patients with CAD who underwent PCI with DCB. The presence of CKD provides useful information for the risk stratification of CAD patients who underwent PCI with DCB. Data Availability The data underlying this article are available in the article and in its supplemental materials. Disclosures The authors declare no conflicts of interest. Acknowledgments The authors thank Editage ( www.editage.jp ) for English language review. References 1. ↵ Scheller B , Hehrlein C , Bocksch W , Rutsch W , Haghi D , Dietz U , Böhm M , Speck U . Treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter . N Engl J Med . 2006 ; 355 : 2113 – 2124 . OpenUrl CrossRef PubMed Web of Science 2. ↵ Jeger R V , Farah A , Ohlow M-A , Mangner N , Möbius-Winkler S , Leibundgut G , Weilenmann D , Wöhrle J , Richter S , Schreiber M , Mahfoud F , Linke A , Stephan F-P , Mueller C , Rickenbacher P , Coslovsky M , Gilgen N , Osswald S , Kaiser C , Scheller B . Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial. Lancet (London , England) . 2018 ; 392 : 849 – 856 . OpenUrl 3. ↵ Jeger R V , Farah A , Ohlow M-A , Mangner N , Möbius-Winkler S , Weilenmann D , Wöhrle J , Stachel G , Markovic S , Leibundgut G , Rickenbacher P , Osswald S , Cattaneo M , Gilgen N , Kaiser C , Scheller B . Long-term efficacy and safety of drug-coated balloons versus drug-eluting stents for small coronary artery disease (BASKET-SMALL 2): 3-year follow-up of a randomised, non-inferiority trial. Lancet (London , England) . 2020 ; 396 : 1504 – 1510 . OpenUrl 4. ↵ Shin ES , Jun EJ , Kim S , Kim B , Kim TH , Sohn CB , Her AY , Park Y , Cho JR , Jeong YH , Choi BJ . Clinical Impact of Drug-Coated Balloon–Based Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease . JACC Cardiovasc Interv . 2023 ; 16 : 292 – 299 . OpenUrl 5. ↵ Gitto M , Sticchi A , Chiarito M , Novelli L , Leone PP , Mincione G , Oliva A , Condello F , Rossi ML , Regazzoli D , Gasparini G , Cozzi O , Stefanini GG , Condorelli G , Reimers B , Mangieri A , Colombo A . Drug-Coated Balloon Angioplasty for de Novo Lesions on the Left Anterior Descending Artery . Circ Cardiovasc Interv . 2023 ; 16 : E013232 . OpenUrl 6. ↵ Leone PP , Oliva A , Regazzoli D , Gitto M , Novelli L , Cozzi O , Stefanini GG , Rossi ML , Sticchi A , Tartaglia F , Mangieri A , Reimers B , Colombo A . Immediate and follow-up outcomes of drug-coated balloon angioplasty in de novo long lesions on large coronary arteries . EuroIntervention J. Eur. Collab. with Work. Gr. Interv. Cardiol. Eur. Soc. Cardiol . 2023 ; 19 : e923 – e925 . OpenUrl 7. ↵ Eckardt K-U , Coresh J , Devuyst O , Johnson RJ , Köttgen A , Levey AS , Levin A . Evolving importance of kidney disease: from subspecialty to global health burden . Lancet (London, England) . 2013 ; 382 : 158 – 169 . OpenUrl 8. ↵ Capodanno D , Angiolillo DJ . Antithrombotic therapy in patients with chronic kidney disease . Circulation . 2012 ; 125 : 2649 – 2661 . OpenUrl FREE Full Text 9. ↵ Jha V , Garcia-Garcia G , Iseki K , Li Z , Naicker S , Plattner B , Saran R , Wang AY-M , Yang C-W . Chronic kidney disease: global dimension and perspectives. Lancet (London , England) . 2013 ; 382 : 260 – 272 . OpenUrl 10. ↵ Coskun U , Orta Kilickesmez K , Abaci O , Kocas C , Bostan C , Yildiz A , Baskurt M , Arat A , Ersanli M , Gurmen T . The relationship between chronic kidney disease and SYNTAX score . Angiology . 2011 ; 62 : 504 – 508 . OpenUrl CrossRef PubMed Web of Science 11. ↵ Go AS , Chertow GM , Fan D , McCulloch CE , Hsu C . Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization . N Engl J Med . 2004 ; 351 : 1296 – 1305 . OpenUrl CrossRef PubMed Web of Science 12. ↵ Lee JM , Kang J , Lee E , Hwang D , Rhee T-M , Park J , Kim H-L , Lee SE , Han J-K , Yang H-M , Park KW , Na S-H , Kang H-J , Koo B-K , Kim H-S . Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry . JACC Cardiovasc Interv . 2016 ; 9 : 2097 – 2109 . OpenUrl Abstract / FREE Full Text 13. ↵ Thygesen K , Alpert JS , Jaffe AS , Chaitman BR , Bax JJ , Morrow DA , White HD . Fourth Universal Definition of Myocardial Infarction (2018) . Circulation . 2018 ; 138 : e618 – e651 . OpenUrl CrossRef PubMed 14. ↵ Knuuti J , Wijns W , Saraste A , Capodanno D , Barbato E , Funck-Brentano C , Prescott E , Storey RF , Deaton C , Cuisset T , Agewall S , Dickstein K , Edvardsen T , Escaned J , Gersh BJ , Svitil P , Gilard M , Hasdai D , Hatala R , Mahfoud F , Masip J , Muneretto C , Valgimigli M , Achenbach S , Bax JJ . 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes . Eur Heart J . 2020; 41 : 407 – 477 . OpenUrl CrossRef 15. ↵ Lawton JS , Tamis-Holland JE , Bangalore S , Bates ER , Beckie TM , Bischoff JM , Bittl JA , Cohen MG , DiMaio JM , Don CW , Fremes SE , Gaudino MF , Goldberger ZD , Grant MC , Jaswal JB , Kurlansky PA , Mehran R , Metkus TSJ , Nnacheta LC , Rao S V , Sellke FW , Sharma G , Yong CM , Zwischenberger BA . 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines . Circulation . 2022; 145 : e18 – e114 . OpenUrl 16. ↵ Kimura K , Kimura T , Ishihara M , Nakagawa Y , Nakao K , Miyauchi K , Sakamoto T , Tsujita K , Hagiwara N , Miyazaki S , Ako J , Arai H , Ishii H , Origuchi H , Shimizu W , Takemura H , Tahara Y , Morino Y , Iino K , Itoh T , Iwanaga Y , Uchida K , Endo H , Kongoji K , Sakamoto K , Shiomi H , Shimohama T , Suzuki A , Takahashi J , Takeuchi I , Tanaka A , Tamura T , Nakashima T , Noguchi T , Fukamachi D , Mizuno T , Yamaguchi J , Yodogawa K , Kosuge M , Kohsaka S , Yoshino H , Yasuda S , Shimokawa H , Hirayama A , Akasaka T , Haze K , Ogawa H , Tsutsui H , Yamazaki T. JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome . Circ J . 2019; 83 : 1085 – 1196 . OpenUrl 17. ↵ Nakamura M , Yaku H , Ako J , Arai H , Asai T , Chikamori T , Daida H , Doi K , Fukui T , Ito T , Kadota K , Kobayashi J , Komiya T , Kozuma K , Nakagawa Y , Nakao K , Niinami H , Ohno T , Ozaki Y , Sata M , Takanashi S , Takemura H , Ueno T , Yasuda S , Yokoyama H , Fujita T , Kasai T , Kohsaka S , Kubo T , Manabe S , Matsumoto N , Miyagawa S , Mizuno T , Motomura N , Numata S , Nakajima H , Oda H , Otake H , Otsuka F , Sasaki K-I , Shimada K , Shimokawa T , Shinke T , Suzuki T , Takahashi M , Tanaka N , Tsuneyoshi H , Tojo T , Une D , Wakasa S , Yamaguchi K , Akasaka T , Hirayama A , Kimura K , Kimura T , Matsui Y , Miyazaki S , Okamura Y , Ono M , Shiomi H , Tanemoto K. JCS/JSCVS 2018 Guideline on Revascularization of Stable Coronary Artery Disease . Circ J . 2022 ; 86 : 477 – 588 . OpenUrl 18. ↵ Neumann F-J , Sousa-Uva M , Ahlsson A , Alfonso F , Banning AP , Benedetto U , Byrne RA , Collet J-P , Falk V , Head SJ , Jüni P , Kastrati A , Koller A , Kristensen SD , Niebauer J , Richter DJ , Seferovic PM , Sibbing D , Stefanini GG , Windecker S , Yadav R , Zembala MO . 2018 ESC/EACTS Guidelines on myocardial revascularization . Eur Heart J . 2019 ; 40 : 87 – 165 . OpenUrl CrossRef 19. ↵ Matsuo S , Imai E , Horio M , Yasuda Y , Tomita K , Nitta K , Yamagata K , Tomino Y , Yokoyama H , Hishida A . Revised equations for estimated GFR from serum creatinine in Japan . Am J kidney Dis Off J Natl Kidney Found . 2009 ; 53 : 982 – 992 . OpenUrl 20. ↵ KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease . Kidney Int . 2020 ; 98 : S1 – S115 . OpenUrl 21. ↵ Mehran R , Rao S V , Bhatt DL , Gibson CM , Caixeta A , Eikelboom J , Kaul S , Wiviott SD , Menon V , Nikolsky E , Serebruany V , Valgimigli M , Vranckx P , Taggart D , Sabik JF , Cutlip DE , Krucoff MW , Ohman EM , Steg PG , White H . Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium . Circulation . 2011 ; 123 : 2736 – 2747 . OpenUrl FREE Full Text 22. ↵ Stone GW , Christiansen EH , Ali ZA , Andreasen LN , Maehara A , Ahmad Y , Landmesser U , Holm NR . Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis . Lancet [Internet] . 2024 ; 403 : 824 – 837 . Available from : doi: 10.1016/S0140-6736(23)02454-6 OpenUrl CrossRef 23. ↵ Watanabe H , Domei T , Morimoto T , Natsuaki M , Shiomi H , Toyota T , Ohya M , Suwa S , Takagi K , Nanasato M , Hata Y , Yagi M , Suematsu N , Yokomatsu T , Takamisawa I , Doi M , Noda T , Okayama H , Seino Y , Tada T , Sakamoto H , Hibi K , Abe M , Kawai K , Nakao K , Ando K , Tanabe K , Ikari Y , Hanaoka KI , Morino Y , Kozuma K , Kadota K , Furukawa Y , Nakagawa Y , Kimura T . Effect of 1-Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12-Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI: The STOPDAPT-2 Randomized Clinical Trial . JAMA . 2019 ; 321 : 2414 – 2427 . OpenUrl CrossRef PubMed 24. ↵ Madhavan M V. , Kirtane AJ , Redfors B , Généreux P , Ben-Yehuda O , Palmerini T , Benedetto U , Biondi-Zoccai G , Smits PC , von Birgelen C , Mehran R , McAndrew T , Serruys PW , Leon MB , Pocock SJ , Stone GW . Stent-Related Adverse Events >1 Year After Percutaneous Coronary Intervention . J Am Coll Cardiol . 2020 ; 75 : 590 – 604 . OpenUrl FREE Full Text 25. ↵ Nakamura D , Attizzani GF , Toma C , Sheth T , Wang W , Soud M , Aoun R , Tummala R , Leygerman M , Fares A , Mehanna E , Nishino S , Fung A , Costa MA , Bezerra HG . Failure Mechanisms and Neoatherosclerosis Patterns in Very Late Drug-Eluting and Bare-Metal Stent Thrombosis . Circ Cardiovasc Interv . 2016 ; 9 : 1 – 9 . OpenUrl PubMed 26. ↵ Gray WA , Granada JF . Drug-coated balloons for the prevention of vascular restenosis . Circulation . 2010 ; 121 : 2672 – 2680 . OpenUrl FREE Full Text 27. ↵ Hwang D , Kang J , Yang H-M , Yang S , Park J , Han J-K , Kang H-J , Koo B-K , Kim H-S . Better Prognosis After Complete Revascularization Using Contemporary Coronary Stents in Patients With Chronic Kidney Disease . Circ Cardiovasc Interv . 2019 ; 12 : e007907 . OpenUrl 28. ↵ Jankowski J , Floege J , Fliser D , Böhm M , Marx N . Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options . Circulation . 2021 ; 143 : 1157 – 1172 . OpenUrl CrossRef PubMed View the discussion thread. Back to top Previous Next Posted June 21, 2024. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Impact of Chronic Kidney Disease on Clinical Outcomes after Percutaneous Coronary Intervention with Drug-Coated Balloons Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Impact of Chronic Kidney Disease on Clinical Outcomes after Percutaneous Coronary Intervention with Drug-Coated Balloons Tetsuya Takahashi , Tetsu Watanabe , Mashu Toyoshima , Wataru Katawaki , Taku Toshima , Yu Kumagai , Tamon Yamanaka , Masafumi Watanabe medRxiv 2024.06.20.24309055; doi: https://doi.org/10.1101/2024.06.20.24309055 Share This Article: Copy Citation Tools Impact of Chronic Kidney Disease on Clinical Outcomes after Percutaneous Coronary Intervention with Drug-Coated Balloons Tetsuya Takahashi , Tetsu Watanabe , Mashu Toyoshima , Wataru Katawaki , Taku Toshima , Yu Kumagai , Tamon Yamanaka , Masafumi Watanabe medRxiv 2024.06.20.24309055; doi: https://doi.org/10.1101/2024.06.20.24309055 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Cardiovascular Medicine Subject Areas All Articles Addiction Medicine (573) Allergy and Immunology (865) Anesthesia (302) Cardiovascular Medicine (4453) Dentistry and Oral Medicine (444) Dermatology (383) Emergency Medicine (609) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1515) Epidemiology (15242) Forensic Medicine (30) Gastroenterology (1131) Genetic and Genomic Medicine (6615) Geriatric Medicine (669) Health Economics (1001) Health Informatics (4552) Health Policy (1372) Health Systems and Quality Improvement (1614) Hematology (543) HIV/AIDS (1270) Infectious Diseases (except HIV/AIDS) (15929) Intensive Care and Critical Care Medicine (1106) Medical Education (624) Medical Ethics (147) Nephrology (670) Neurology (6625) Nursing (346) Nutrition (999) Obstetrics and Gynecology (1148) Occupational and Environmental Health (957) Oncology (3344) Ophthalmology (979) Orthopedics (369) Otolaryngology (421) Pain Medicine (436) Palliative Medicine (130) Pathology (665) Pediatrics (1696) Pharmacology and Therapeutics (693) Primary Care Research (714) Psychiatry and Clinical Psychology (5461) Public and Global Health (9252) Radiology and Imaging (2207) Rehabilitation Medicine and Physical Therapy (1371) Respiratory Medicine (1197) Rheumatology (597) Sexual and Reproductive Health (715) Sports Medicine (530) Surgery (714) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a02cbd111d631636',t:'MTc3OTk2NTg0Nw=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();