Association between Percutaneous Coronary Intervention and Long-Term Clinical Outcomes in Patients with Chronic Kidney Disease and Acute Myocardial Infarction

BACKGROUND: Patients with chronic kidney disease (CKD) are at a high risk of adverse outcomes after acute myocardial infarction (AMI); however, evidence on long-term outcomes after percutaneous coronary intervention (PCI) in this population remains limited. METHODS: This prospective cohort study, nested within the Kailuan Study, included patients with CKD who experienced AMI between 2006 and 2020. Participants were classified into PCI and non-PCI groups based on documented PCI receipt and were matched 1:2 on age and sex (452 PCI; 745 non-PCI). Follow-up began at the time of AMI diagnosis or PCI and continued until December 31, 2023. The primary outcome was all-cause mortality, with secondary outcomes being new-onset heart failure and CKD progression. Time-segmented Cox models were used for all-cause mortality, and standard Cox models were used for secondary outcomes. RESULTS: During follow-up, PCI receipt was associated with a lower risk of all-cause mortality compared with no PCI. The association was stronger during the first 5 years of follow-up (hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.24-0.47) and was attenuated thereafter (HR, 0.73; 95% CI, 0.51-1.04). No significant associations were observed between PCI receipt and either new-onset heart failure (HR, 1.06; 95% CI, 0.72-1.57) or CKD progression (HR, 1.11; 95% CI, 0.72-1.71). CONCLUSION: In patients with CKD and AMI, PCI was associated with lower all-cause mortality during the first 5 years of follow-up, with no significant differences in new-onset heart failure or CKD progression.