The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency.
BACKGROUND
Acute deterioration in renal function is a recognized complication after coronary angiography and intervention.


OBJECTIVE
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 > or = 1.8 mg/dL (159.1 /micromol/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 > or = 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.
Gruberg
L
L
Cardiac Catheterization Laboratory, Washington Hospital Center, DC 20010, USA.
Mintz
G S
GS
Mehran
R
R
Gangas
G
G
Lansky
A J
AJ
Kent
K M
KM
Pichard
A D
AD
Satler
L F
LF
Leon
M B
MB
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D008297:Male; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors