Patients with atrial fibrillation face high cardiovascular risk after percutaneous coronary intervention. Chronic kidney disease worsens prognosis through uremic cardiomyopathy and bleeding diathesis. 
This study, published in the Journal of Cardiology, included 902 atrial fibrillation patients undergoing PCI. Researchers grouped them by kidney function. Normal renal function meant eGFR ≥60 mL/min/1.73m2. Early CKD covered 30 ≤ eGFR <60 mL/min/1.73m2. Advanced CKD included eGFR <30 mL/min/1.73m2 or hemodialysis patients. Primary endpoint tracked net adverse clinical events within 1 year. This composite included all-cause death, myocardial infarction, ischemic stroke, and major bleeding.
CKD Distribution Reflects PCI Population
Among 902 patients, 338 had normal kidney function. This was 37.5%. Early CKD affected 438 patients or 48.5%. Advanced CKD occurred in 126 patients representing 14.0%. These proportions mirror typical PCI cohorts with progressive renal impairment.
NACE Rates Rise with CKD Progression
One-year follow-up showed 142 NACE events. This equaled 15.7% incidence. Advanced CKD patients faced highest risk. All-cause death drove differences across groups. Myocardial infarction rates stayed similar between CKD stages. Ischemic stroke showed no significant variation. Major bleeding events remained comparable across renal function categories.
Death Risk Dominates Composite Endpoint
Advanced CKD associated with significantly higher NACE incidence versus early CKD or normal function. Bleeding Academic Research Consortium type 3 or 5 events occurred equally. Ischemic complications lacked CKD gradient. All-cause mortality emerged as primary differentiator confirming uremic milieu accelerates post-PCI mortality through arrhythmogenic substrate potentiation.
Anticoagulation Strategies Need Refinement
Cardiologists must tailor antithrombotic regimens by CKD stage in atrial fibrillation PCI patients. Advanced CKD patients require closer mortality risk counseling alongside dialysis-dependent thrombosis prophylaxis optimization. Early CKD justifies standard triple therapy duration while normal function permits de-escalation protocols. Renal function guided net adverse clinical event minimization represents essential PCI risk stratification paradigm.