Clinical outcome following percutaneous coronary interventions in patients with chronic renal failure.
The clinical outcome of patients with chronic renal failure (CRF) who undergo percutaneous coronary intervention (PCI) has not been systematically evaluated in a large cohort of patients. We retrospectively analyzed the in-hospital and 1-year clinical outcomes of 10,076 consecutive patients who underwent PCI between January 1994 and December 1997. A total of 95 patients (0.9%) had end-stage renal disease (ESRD) on dialysis, 786 patients (7.8%) had CRF, and 9,125 patients (90.6%) had normal renal function. Despite an angiographic success rate of 97% in all three groups, in-hospital mortality was significantly higher among patients with renal disease, whether they were on dialysis or not, when compared to patients without renal dysfunction (6.8% vs. 4.2% vs. 0.9%; P < 0.0001). At 1-year follow-up, mortality rate was 48.8% for ESRD, 25.7% for patients with CRF, and 5.5%, for patients without renal dysfunction (P < 0.0001). By multivariate analysis, high left ventricular ejection fraction and creatinine clearance were associated with decreased late mortality (OR = 0.84 and 0.95; P < 0.0001), whereas ESRD (OR = 3.65; P = 0.0002), non-Q-wave myocardial infarction (OR = 2.21; P < 0.0001), diabetes mellitus (OR = 1.99; P < 0.0001), and CRF (OR = 1.74; P = 0.003) were independent correlates of increased late mortality. Therefore, PCI in patients with impaired renal function, whether on dialysis or not, is associated with poor in-hospital and 1-year survival.
Gruberg
Luis
L
Department of Cardiology, Rambam Medical Center, Haifa, Israel. gruberg67@hotmail.com
Dangas
George
G
Mehran
Roxana
R
Mintz
Gary S
GS
Kent
Kenneth M
KM
Pichard
Augusto D
AD
Satler
Lowell F
LF
Lansky
Alexandra J
AJ
Stone
Gregg W
GW
Leon
Martin B
MB
D000368:Aged; D017225:Atherectomy, Coronary; D016001:Confidence Intervals; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications* / Q000628:therapy*; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D006435:Renal Dialysis; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D003404:Creatinine