Impact of Chronic Kidney Disease Severity on Clinical Outcomes After Drug‐Eluting Stent Implantation: A Propensity Score–Matched Analysis
Hongxu Zhu, Qi JinABSTRACT
Background
Chronic kidney disease (CKD) is prevalent among patients undergoing percutaneous coronary intervention (PCI) and associated with adverse cardiovascular outcomes. This study evaluated the association between moderate‐to‐severe CKD and major adverse cardiovascular events (MACE) after drug‐eluting stent (DES) implantation using propensity score matching.
Methods
This retrospective cohort study included 200 patients undergoing PCI with DES implantation (January 2020 to January 2025). Patients were stratified by baseline eGFR: non‐CKD/mild CKD (≥ 60 mL/min/1.73 m 2 ); and moderate‐to‐severe CKD (< 60 mL/min/1.73 m 2 ). After 1:1 propensity score matching, 55 pairs were analyzed. The primary endpoint was MACE, defined as all‐cause death, myocardial infarction, stroke, or ischemia‐driven repeat revascularization.
Results
After matching, patients with moderate‐to‐severe CKD had lower MACE‐free survival (log‐rank p = 0.003). Cox regression with robust sandwich standard errors clustered by matched pair showed that moderate‐to‐severe CKD was independently associated with higher MACE risk (HR 3.20, 95% CI 1.36–7.53; p = 0.008). Renal function deterioration (eGFR decline ≥ 30%) occurred more frequently in the CKD group (20.0% vs. 3.6%; p = 0.028). Higher rates of BARC type 2–5 bleeding and contrast‐associated AKI were observed in the CKD group; contrast‐associated AKI reached statistical significance in the matched analysis ( p = 0.030). Sensitivity analysis using inverse probability of treatment weighting supported the robustness of these findings (MACE: p < 0.001).
Conclusions
Moderate‐to‐severe CKD was independently associated with a higher risk of MACE and renal deterioration after DES implantation. These findings support incorporating CKD severity into post‐PCI risk stratification and highlight the potential value of integrated cardiorenal monitoring and individualized management in this high‐risk population.