• 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, and Jingang Zheng.
• Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
• Chin. Med. J. 2024 Sep 25.

BackgroundThe 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.MethodsThis 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.ResultsOf 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.ConclusionThis 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.Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.

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