Acute renal failure requiring dialysis after percutaneous coronary interventions.
Acute renal failure requiring dialysis is a rare but serious complication after percutaneous coronary interventions (PCI), associated with high in-hospital mortality and poor long-term survival. We have analyzed the incidence, resource utilization, short- and long-term outcomes, and predictors of dialysis after percutaneous coronary interventions. We studied 51 consecutive patients who were not on dialysis on admission and developed acute renal failure that required in-hospital dialysis after PCI in comparison to the 7,690 patients who did not require dialysis after PCI. Patients who required dialysis were older, with a higher incidence of hypertension, diabetes, prior bypass surgery, chronic renal failure, and a significantly lower left ventricular ejection fraction. Despite similar angiographic success, these patients had a higher incidence of in-hospital mortality (27.5% vs. 1.0%, P < 0.0001), non-Q-wave myocardial infarction (45.7% vs. 14.6%, P < 0.0001), vascular and bleeding complications, and longer hospitalization. At 1-year follow-up, mortality (54.5% vs. 6.4%, P < 0.0001), myocardial infarction (4.5% vs. 1.6%, P = 0.006), and event-free survival (38.6% vs. 72.0%, P < 0.0001) were significantly worse in patients who required dialysis compared to patients who did not. Multivariate analysis revealed in-hospital dialysis and an increase in baseline serum creatinine levels as the most important predictors of in-hospital and long-term mortality. Thus, acute renal failure that requires dialysis after percutaneous coronary interventions is associated with very high in-hospital and 1-year mortality rates and a dramatic increase in hospital resource utilization.
Gruberg
L
L
Division of Cardiology, Washington Hospital Center, Washington, D.C. 20010, USA. lxg6@mhg.edu
Mehran
R
R
Dangas
G
G
Mintz
G S
GS
Waksman
R
R
Kent
K M
KM
Pichard
A D
AD
Satler
L F
LF
Wu
H
H
Leon
M B
MB
D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000401:mortality; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007527:Isoenzymes / Q000097:blood; D007668:Kidney / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D008657:Metabolic Clearance Rate / Q000502:physiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D006435:Renal Dialysis; D012737:Sex Factors; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome
D007527:Isoenzymes; D003404:Creatinine; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form