Cause-Specific Mortality in Patients With Advanced Chronic Kidney Disease in the ISCHEMIA-CKD Trial |
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| Affiliation: | 1. Albany Medical College, Albany, New York, USA;2. Duke Clinical Research Institute and Duke University, Durham, North Carolina, USA;3. Veterans Affairs Loma Linda Healthcare System, Loma Linda, California, USA;4. New York University Grossman School of Medicine, New York, New York, USA;5. Mayo Clinic, Rochester, Minnesota, USA;6. National Research Center for Cardiovascular Surgery, Moscow, Russia;7. Mediterranea Cardiocentro, Naples, Italy;8. National Medical Research Center of Ministry of Health of Russia, Novosibirsk, Russia;9. Medical University of Warsaw, Warsaw, Poland;10. Azienda Ospedaliero Universitaria Careggi, Florence, Italy;11. Department of Internal Medicine and Cardiology, Infant Jesus Teaching Hospital, Medical University of Warsaw, Warsaw, Poland;12. Government Medical College, Calicut, India;13. Russian Medical Academy of Continuous Professional Education, City Clinical Hospital named after S.P. Botkin, Moscow, Russia;14. Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA;15. Columbia University, New York, New York, USA;p. Icahn School of Medicine at Mount Sinai, Cardiovascular Research Foundation, New York, New York, USA;q. St. Louis University School of Medicine Center for Comprehensive Cardiovascular Care, St. Louis, Missouri, USA;r. St. Michael’s Hospital, University of Toronto and the Canadian Heart Research Centre, Toronto, Ontario, Canada;s. National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA;t. Department of Medicine, Stanford University School of Medicine, Stanford, California, USA |
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| Abstract: | ![]()
BackgroundIn ISCHEMIA-CKD, 777 patients with advanced chronic kidney disease and chronic coronary disease had similar all-cause mortality with either an initial invasive or conservative strategy (27.2% vs 27.8%, respectively).ObjectivesThis prespecified secondary analysis from ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease) was conducted to determine whether an initial invasive strategy compared with a conservative strategy decreased the incidence of cardiovascular (CV) vs non-CV causes of death.MethodsThree-year cumulative incidences were calculated for the adjudicated cause of death. Overall and cause-specific death by treatment strategy were analyzed using Cox models adjusted for baseline covariates. The association between cause of death, risk factors, and treatment strategy were identified.ResultsA total of 192 of the 777 participants died during follow-up, including 94 (12.1%) of a CV cause, 59 (7.6%) of a non-CV cause, and 39 (5.0%) of an undetermined cause. The 3-year cumulative rates of CV death were similar between the invasive and conservative strategies (14.6% vs 12.6%, respectively; HR: 1.13, 95% CI: 0.75-1.70). Non-CV death rates were also similar between the invasive and conservative arms (8.4% and 8.2%, respectively; HR: 1.25; 95% CI: 0.75-2.09). Sudden cardiac death (46.8% of CV deaths) and infection (54.2% of non-CV deaths) were the most common cause-specific deaths and did not vary by treatment strategy.ConclusionsIn ISCHEMIA-CKD, CV death was more common than non-CV or undetermined death during the 3-year follow-up. The randomized treatment assignment did not affect the cause-specific incidences of death in participants with advanced CKD and moderate or severe myocardial ischemia. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease [ISCHEMIA-CKD]; NCT01985360) |
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| Keywords: | chronic coronary artery disease chronic kidney disease death medical therapy myocardial revascularization CCD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" chronic coronary disease CEC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" clinical events committee CKD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" chronic kidney disease CV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" cardiovascular eGFR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" estimated glomerular filtration rate GDMT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" guideline-directed medical therapy LVEF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" left ventricular ejection fraction MI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" myocardial infarction SCD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" sudden cardiac death |
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