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J Am Coll Cardiol, 2000; 36:1542-1548
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDY

The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency

Luis Gruberg, MD*, Gary S. Mintz, MD*, Roxana Mehran, MD{dagger}, George Dangas, MD, PhD{dagger}, Alexandra J. Lansky, MD{dagger}, Kenneth M. Kent, MD, PhD*, Augusto D. Pichard, MD*, Lowell F. Satler, MD* and Martin B. Leon, MD{dagger}

* Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, DC, USA
{dagger} Cardiovascular Research Foundation, New York, New York, USA

Manuscript received January 21, 2000; revised manuscript received April 19, 2000, accepted June 19, 2000.

Reprint requests and correspondence: Dr. Gary S. Mintz, Washington Hospital Center, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010
gsm1{at}mhg.edu

BACKGROUND

Acute deterioration in renal function is a recognized complication after coronary angiography and intervention.

OBJECTIVES

The goal of this study was to determine the impact on acute and long-term mortality and morbidity of contrast-induced deterioration in renal function after coronary intervention.

METHODS

We studied 439 consecutive patients who had a baseline serum creatinine ≥1.8 mg/dL (159.1 µmol/L) who were not on dialysis who underwent percutaneous coronary intervention in a tertiary referral center. All patients were hydrated before the procedure, and almost all received ioxaglate meglumine; 161 (37%) patients had an increase in serum creatinine ≥25% within 48 h or required dialysis and 278 (63%) did not. In-hospital and out-of-hospital clinical events (death, myocardial infarction, repeat revascularization) were assessed by source documentation.

RESULTS

Independent predictors of renal function deterioration were left ventricular ejection fraction (p = 0.02) and contrast volume (p = 0.01). In-hospital mortality was 14.9% for patients with further renal function deterioration versus 4.9% for patients with no creatinine increase (p = 0.001); other complications were also more frequent. Thirty-one patients required hemodialysis; their in-hospital mortality was 22.6%. Four patients were discharged on chronic dialysis. The cumulative one-year mortality was 45.2% for those who required dialysis, 35.4% for those who did not require dialysis and 19.4% for patients with no creatinine increase (p = 0.001). Independent predictors of one-year mortality were creatinine elevation (p = 0.0001), age (p = 0.03) and vein graft lesion location (p = 0.08).

CONCLUSIONS

For patients with pre-existing renal insufficiency, renal function deterioration after coronary intervention is a marker for poor outcomes. This is especially true for patients who require dialysis.

Abbreviations and Acronyms
  CI = confidence interval
  CrCl = creatinine clearance
  CRI = chronic renal insufficiency
  MI = myocardial infarction
  OR = odds ratio




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