Poor long-term survival after coronary angiography in patients with renal insufficiency.
Cardiovascular disease is common among dialysis patients, but much less is known regarding non-dialysis-dependent renal insufficiency (NDDRI) and its association with cardiac disease. We undertook a study to assess the impact of renal insufficiency on survival post-coronary angiography by comparing three groups of patients: dialysis-dependent patients, patients with NDDRI (creatinine > 2.3 mg/dL), and a reference group with creatinine levels less than 2.3 mg/dL and not on dialysis therapy. We used a prospective cohort that consisted of all patients undergoing coronary angiography in Alberta, Canada, from January 1, 1995, to December 31, 1997. Of the 16,989 patients, 196 patients (1.2%) were on dialysis therapy, 262 patients (1.5%) had NDDRI, and 16,531 patients (97.3%) formed the reference group. Mortality rates 1 year after angiography were 30.2% for patients with NDDRI, 15.8% for dialysis patients, and 4.1% for the reference group. Compared with the reference group, crude 4-year survival was significantly worse for dialysis patients and those with NDDRI, with hazard ratios of 4.05 (95% confidence interval, 3.02 to 5.42) and 7.32 (95% confidence interval, 5.97 to 8.97), respectively. Even after adjusting for clinical risk factors, survival remained worse for dialysis patients and those with NDDRI, with hazard ratios of 2.59 (95% confidence interval, 1.92 to 3.49) and 2.51 (95% confidence interval, 2.02 to 3.12), respectively. We conclude that renal insufficiency, both dialysis dependent and non-dialysis dependent, is an independent risk factor for increased mortality and poor long-term survival among patients undergoing coronary angiography.
Hemmelgarn
B R
BR
Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Ghali
W A
WA
Quan
H
H
Brant
R
R
Norris
C M
CM
Taub
K J
KJ
Knudtson
M L
ML
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography / Q000401:mortality*; D001026:Coronary Artery Bypass; D003956:Dialysis; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate