CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions
Patricia J. M. Best, MD*,
Ryan Lennon*,
Henry H. Ting, MD*,
Malcolm R. Bell, MD, FACC*,
Charanjit S. Rihal, MD, FACC*,
David R. Holmes, Jr, MD, FACC* and
Peter B. Berger, MD, FACC*,*
* Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Manuscript received September 25, 2001;
revised manuscript received January 3, 2002,
accepted January 16, 2002.
* Reprint requests and correspondence: Dr. Peter Berger, Division of Cardiovascular Diseases, Mayo Clinic, W16, 200 First Street SW, Rochester, Minnesota 55905, USA.
berger.peter{at}mayo.edu
OBJECTIVES: 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).
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
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Abbreviations and Acronyms
| | CABG | | coronary artery bypass graft surgery | | CAD | | coronary artery disease | | CI | | confidence interval | | MI | | myocardial infarction | | PCI | | percutaneous coronary intervention | | RR | | risk ratio |
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The Prevention of Radiocontrast-Agent-Induced Nephropathy by Hemofiltration
N. Engl. J. Med.,
October 2, 2003;
349(14):
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[Abstract]
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C. A. Herzog
How to Manage the Renal Patient with Coronary Heart Disease: The Agony and the Ecstasy of Opinion-Based Medicine
J. Am. Soc. Nephrol.,
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J. S. Zebrack, J. L. Anderson, S. Beddhu, B. D. Horne, T. L. Bair, A. Cheung, J. B. Muhlestein, and Intermountain Heart Collaborative Study Group
Do associations with C-Reactive protein and extent of coronary artery disease account for the increased cardiovascular risk of renal insufficiency?
J. Am. Coll. Cardiol.,
July 2, 2003;
42(1):
57 - 63.
[Abstract]
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J. Kay
Acetylcysteine and Renal Function Following Coronary Angiographic Procedures--Reply
JAMA,
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289(21):
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[Full Text]
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R. V. Freeman, R. H. Mehta, W. Al Badr, J. V. Cooper, E. Kline-Rogers, and K. A. Eagle
Influence of concurrent renal dysfunction on outcomes of patients with acute coronary syndromes and implications of the use of glycoprotein IIb/IIIa inhibitors
J. Am. Coll. Cardiol.,
March 5, 2003;
41(5):
718 - 724.
[Abstract]
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J. Kay, W. H. Chow, T. M. Chan, S. K. Lo, O. H. Kwok, A. Yip, K. Fan, C. H. Lee, and W. F. Lam
Acetylcysteine for Prevention of Acute Deterioration of Renal Function Following Elective Coronary Angiography and Intervention: A Randomized Controlled Trial
JAMA,
February 5, 2003;
289(5):
553 - 558.
[Abstract]
[Full Text]
[PDF]
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G. Manjunath, H. Tighiouart, H. Ibrahim, B. MacLeod, D. N. Salem, J. L. Griffith, J. Coresh, A. S. Levey, and M. J. Sarnak
Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community
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January 1, 2003;
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[Abstract]
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K.-G. i Shyu, J.-J. Cheng, and P. Kuan
Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure
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October 16, 2002;
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[Abstract]
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D. N. Reddan and P. S. Klassen
Chronic Kidney Disease and Cardiovascular Risk: Time to Focus on Therapy
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September 1, 2002;
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Renal Insufficiency Predicts Post-PCI Adverse Events
Journal Watch Cardiology,
May 31, 2002;
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[Full Text]
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Renal Insufficiency and Percutaneous Coronary Interventions
Journal Watch (General),
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[Full Text]
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