Grade of chronic renal failure, and acute and long-term outcome after percutaneous coronary interventions.
BACKGROUND
Patients with moderate chronic renal failure have recently been identified to suffer from a markedly higher mortality after percutaneous coronary intervention (PCI). We focused on the outcome of PCI patients with just mildly elevated creatinine levels of 1.1 to 1.5 mg/dL.


METHODS
Data of all PCI patients of the years 1998 to 1999 were analyzed. Follow-up was performed by a questionnaire sent to all patients.


RESULTS
During this period, PCI was performed in 1049 patients. Long-term follow-up (1184 +/- 10 days) was 99.6% complete. Total mortality increased continuously by each creatinine increment of 0.1 mg/dL above 1.0 mg/dL, with a significant difference at 1.3 mg/dL compared to patients with <or=1.0 mg/dL (12.4 vs. 5.5%, P < 0.05). In a Kaplan-Meier model, patients with a creatinine of 1.3 to 1.4 mg/dL had a significantly lower cumulative survival after three years (87%) than controls (96%, P = 0.0108, log rank test). Higher serum creatinine levels were found to be significantly associated with death in univariate analysis (1.1 +/- 0.4 vs. 1.5 +/- 1.0 mg/dL, P < 0.00001), and in multivariate analysis by stepwise logistic regression (OR 2.122, 95% CI 1.585 to 2.841).


CONCLUSIONS
In this retrospective cross-sectional study, even patients with slightly elevated serum creatinine levels of 1.3 to 1.4 mg/dL had a significantly reduced long-term outcome after PCI. Thus, even mild chronic renal failure appears to be associated with markedly increased risk after a PCI, with implications to the high number of patients concerned.
Reinecke
Holger
H
Department of Cardiology and Angiology, Medizinische Klinik und Poliklinik C, University Hospital Münster, Münster, Germany. reinech@uni-muenster.de
Trey
Torsten
T
Matzkies
Fritz
F
Fobker
Manfred
M
Breithardt
Günter
G
Schaefer
Roland M
RM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019540:Area Under Curve; D003327:Coronary Disease / Q000150:complications* / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome
D003404:Creatinine