Impact of renal function on morbidity and mortality after percutaneous aortocoronary saphenous vein graft intervention.
BACKGROUND
Percutaneous coronary intervention in patients with chronic renal insufficiency (CRI) and native coronary artery disease is often problematic, marred by increased morbidity and mortality rates and a high incidence of restenosis and revascularization. However, little is known about the effect of CRI in patients who have undergone prior coronary artery bypass graft surgery and then undergo saphenous vein graft (SVG) intervention.


METHODS
We analyzed the inhospital and 1-year outcomes of 1265 consecutive patients with normal renal function and varying degrees of renal insufficiency who underwent percutaneous SVG intervention and divided them into 4 groups on the basis of the calculated creatinine clearance (CrCl): group 1, CrCl > or =70 mL per minute (n = 626); group 2, CrCl 50 to 69 mL per minute (n = 357); group 3, CrCl 30 to 49 mL per minute (n = 228); and group 4, CrCl <30 mL per minute (n = 54). Patients undergoing dialysis replacement therapy were excluded from the study.


RESULTS
Patients with lower CrCl more often were older, female, had diabetes mellitus, and had worse left ventricular function. Angiographic baseline characteristics were comparable among the 4 groups. Overall immediate procedural success was similar for all groups. Patients with a low CrCl had significantly higher inhospital overall and cardiac mortality rates (P <.001), including a significantly higher incidence of myocardial infarction, vascular complications, pulmonary edema, and renal function deterioration. At 1-year follow-up, the overall mortality rates remained significantly higher in patients with decreased CrCl, with an incremental rise in overall mortality rate associated with lower renal function (P <.001).


CONCLUSIONS
This study suggests that renal function is a primary determinate of short- and long-term survival in patients undergoing percutaneous SVG intervention and that there is a clear relationship between CrCl and cardiovascular outcome.
Gruberg
Luis
L
Division of Cardiology and Cardiovascular Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
Weissman
Neil J
NJ
Pichard
Augusto D
AD
Waksman
Ron
R
Kent
Kenneth M
KM
Satler
Lowell F
LF
Suddath
William O
WO
Pinnow
Ellen E
EE
Gevorkian
Natalie
N
Lindsay
Joseph
J
D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D003401:Creatine / Q000097:blood* / Q000652:urine*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism; D012501:Saphenous Vein / Q000637:transplantation; D016019:Survival Analysis; D016896:Treatment Outcome
D003401:Creatine