The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions

• Published in: Journal of the American College of Cardiology Vol. 39; no. 7; pp. 1113 - 1119
• Main Authors: Best, Patricia J.M, Lennon, Ryan, Ting, Henry H, Bell, Malcolm R, Rihal, Charanjit S, Holmes, David R, Berger, Peter B
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 03.04.2002; Elsevier Science; Elsevier Limited
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary - mortality; Atherectomy, Coronary - mortality; Biological and medical sciences; Cardiology; Clinical outcomes; Coronary Artery Bypass - mortality; Coronary Disease - mortality; Coronary Disease - therapy; Coronary vessels; Diseases of the cardiovascular system; Female; Heart attacks; Hospital Mortality; Humans; Kidney Failure, Chronic - epidemiology; Male; Medical sciences; Middle Aged; Mortality; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries - statistics & numerical data; Renal Insufficiency - epidemiology; Risk Factors; Stents; Treatment Outcome; RR; CABG; MI; CI; CAD; PCI; Kidney disease; Human; Urinary system disease; Mortality; Coronary artery; Instrumentation therapy; Instrumental dilatation; Survival; Percutaneous route; Treatment; Follow up study; Risk factor; Renal failure
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(02)01745-X

We sought to determine the effect of varying degrees of renal insufficiency on death and cardiac events during and after a percutaneous coronary intervention (PCI). Patients with end-stage renal disease have a high mortality from coronary artery disease. Little is known about the impact of mild and moderate renal insufficiency on clinical outcomes after PCI. Cardiac mortality and all-cause mortality were determined for 5,327 patients undergoing PCI from January 1, 1994, to August 31, 1999, at the Mayo Clinic, based on the estimated creatinine clearance or whether the patient was on dialysis. In-hospital mortality was significantly associated with renal insufficiency (p = 0.001). Even after successful PCI, one-year mortality was 1.5% when the creatinine clearance was ≥70 ml/min (n = 2,558), 3.6% when it was 50 to 69 ml/min (n = 1,458), 7.8% when it was 30 to 49 ml/min (n = 828) and 18.3% when it was <30 ml/min (n = 141). The 18.3% mortality rate for the group with <30 ml/min creatinine clearance was similar to the 19.9% mortality rate in patients on dialysis (n = 46). The mortality risk was largely independent of all other factors. Renal insufficiency is a strong predictor of death and subsequent cardiac events in a dose-dependent fashion during and after PCI. Patients with renal insufficiency have more baseline cardiovascular risk factors, but renal insufficiency is associated with an increased risk of death and other adverse cardiovascular events, independent of all other measured variables.