Impact of chronic kidney disease on long-term outcomes after left main percutaneous coronary intervention: a propensity score-matched analysis with up to 10 years of follow-up

INTRODUCTION: Chronic kidney disease (CKD) is a major determinant of adverse cardiovascular outcomes. Patients with CKD undergoing percutaneous coronary intervention (PCI) represent a particularly high-risk population; however, data on the long-term prognostic impact of CKD in patients treated with PCI for left main coronary artery disease (LM CAD) remain limited. OBJECTIVES: This study aimed to evaluate the long-term impact of CKD on outcomes after left main PCI. PATIENTS AND METHODS: This single-center, prospective registry study analyzed 1321 patients who underwent left main PCI. Propensity score matching based on age, sex, diabetes mellitus, left ventricular ejection fraction, and SYNTAX score was performed among patients treated between January 2015 and December 2020, yielding a matched cohort of 344 patients (177 with CKD and 177 without CKD). CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m². RESULTS: During a median follow-up of 2199 days, CKD was associated with significantly higher all-cause mortality (HR 1.75, 95% CI 1.30-2.34; P <0.001), cardiac death (HR 2.10, 95% CI 1.33-3.33; P = 0.001), stroke and major adverse cardiovascular events rates. In contrast, no significant long-term differences were observed between CKD and non-CKD patients in the incidence of myocardial infarction. Procedural characteristics, periprocedural complications, and procedural success rates were comparable between groups. CONCLUSIONS: In patients undergoing PCI for LM CAD, CKD predicts worse long-term survival despite comparable procedural and ischemic outcomes. The excess mortality appears driven by systemic rather than revascularization-related factors, underscoring the need for intensified long-term multidisciplinary management in this high-risk population.