Kidney Stone Formers Have Worse PCI Outcomes

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Patients
who have a history of kidney stones are more likely to have adverse outcomes
following percutaneous coronary intervention (PCI), new data suggest.

Chao-Han
Lai, MD, PhD, of National Cheng Kung University Hospital, College of Medicine,
National Cheng Kung University, Tainan, Taiwan, and colleagues identified adult
patients undergoing first-time PCI at Vanderbilt University Medical Center (VUMC)
in Nashville, Tennessee, and the National Health Insurance Research Database
(NHIRD) in Taiwan. The VUMC and NHIRD cohorts included 11,289 and 155,762
patients, of whom 294 and 12,286 had a history of kidney stones, respectively.

The
median follow-up periods were 2.5 years in the VUMC cohort and 3.7 years in the
NHIRD cohort.

After
matching patients by propensity score, stone formers at VUMC had nearly
2.8-fold increased odds of 30-day in-hospital mortality (the study’s primary
outcome) and 1.6- and 1.4-fold increased risks of myocardial infarction (MI) at
1 and 3 years, respectively, according to a paper published online ahead of
print in Urology. In the NHIRD group,
kidney stone history was significantly associated with significant 12% and 14%
increased risks of MI at 1 and 3 years.

“We
demonstrate that kidney stone patients undergoing PCI have increased risks of
early and late adverse cardiac outcomes,” Dr Lai and colleagues concluded.
“These findings suggest that kidney stone history may be a clinical indicator
to risk-stratify patients undergoing PCI to better inform more aggressive
secondary cardiac prevention measures. Our study adds to the growing body of
literature linking kidney stone disease and coronary artery disease.”

The
authors wrote that it “is plausible to speculate that kidney stone disease is a
marker of the presence of more severe clinical or subclinical cardiovascular
risk factors leading to poorer outcomes following PCI.”

Reference

Lai
CH, Huang LC, Holby SN, et al. Kidney stone history and adverse outcomes after
percutaneous coronary intervention, Urology
(2019).

doi:
https://doi.org/10.1016/j.urology.2019.10.009

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