Coronary artery disease
Renal insufficiency is an independent predictor of mortality after percutaneous coronary intervention

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Abstract

The present study was designed to evaluate whether the presence of renal disease during percutaneous coronary intervention (PCI) is associated with worse outcomes at 1 year in a multicenter study. The incidence of death, myocardial infarction, coronary artery bypass grafting, repeat PCI, and repeat revascularization were prospectively collected on 4,602 patients (6,542 lesions) in 2 waves of patients who underwent PCI in 17 centers between July 1997 and June 1999. Renal disease was defined as the presence of an increased creatinine level in a patient with a history or presence of renal failure treated with low protein diet or dialysis. Patients with renal disease (n = 192) were older and more likely to have diabetes, heart failure, reduced ejection fraction, known coronary disease, and multivessel disease than patients without renal disease (n = 4,410). Rates of stenting were equivalent (68.2% vs 73.0%, p = NS). Patients with renal disease had lower angiographic success (84.9% vs 92.8%, p <0.001) and higher mortality, both in-hospital (5.7% vs 1.2%, p <0.001) and at 1 year (19.7% vs 4.4%, p <0.0001). After adjusting for clinical, demographic, and angiographic differences, renal disease remained an independent predictor of in-hospital (odds ratio 3.81, 95% confidence interval 1.70 to 8.58) and 1-year (risk ratio 2.46, 95% confidence interval 1.64 to 3.68) mortality. Renal disease conferred additional mortality risk in established high-risk clinical subgroups. In conclusion, after adjusting for a higher frequency of co-morbidities, renal disease remains a strong and independent predictor of increased in-hospital and 1-year mortality after PCI and is additive to other clinical markers of worse outcome.

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Methods

The National Heart, Lung, and Blood Institute Dynamic Registry has been previously described6 and comprises patients who underwent PCI at 17 medical centers in the United States, Canada, and the Czech Republic during 2 waves of patient recruitment. There were no exclusion criteria, and initial and repeat interventional procedures were included. The first wave of enrollment was between July 1997 and February 1998 (n = 2,524 patients), and the second wave was between February and June 1999 (n =

Results

In total, 4,602 patients were enrolled and renal disease was present in 192 (4.2%; Table 1). Mean age for all patients was 62.8 years, and 64.2% were men. A random sampling of 71 patients with and 72 patients without renal disease revealed mean creatinine values of 3.3 ± 3.1 and 0.98 ± 0.25 mg/dl, respectively. This corresponded to mean creatinine clearances of 40.3 ± 28.4 and 96.2 ± 36.0 ml/min using the Cockroft-Gault formula. Patients with renal disease were more likely to be older, black,

Discussion

Whereas prior studies have evaluated the relative risk of renal disease on mortality compared with the relative risk conferred by other more established risk factors, the present study has shown that the risk imparted by renal disease is additive to other established risk factors of poor outcome (Table 4). In particular, over half of patients with renal disease presenting with acute MI either died or had another MI at 1 year (51.2% vs 11.7%, p <0.0001). This highly significant association was

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This study was funded in part by grant HL33292-14 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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