Renal insufficiency is an independent predictor of mortality after percutaneous coronary intervention.
The present study was designed to evaluate whether the presence of renal disease during percutaneous coronary intervention (PCI) is associated with worse outcomes at 1 year in a multicenter study. The incidence of death, myocardial infarction, coronary artery bypass grafting, repeat PCI, and repeat revascularization were prospectively collected on 4,602 patients (6,542 lesions) in 2 waves of patients who underwent PCI in 17 centers between July 1997 and June 1999. Renal disease was defined as the presence of an increased creatinine level in a patient with a history or presence of renal failure treated with low protein diet or dialysis. Patients with renal disease (n = 192) were older and more likely to have diabetes, heart failure, reduced ejection fraction, known coronary disease, and multivessel disease than patients without renal disease (n = 4,410). Rates of stenting were equivalent (68.2% vs 73.0%, p = NS). Patients with renal disease had lower angiographic success (84.9% vs 92.8%, p <0.001) and higher mortality, both in-hospital (5.7% vs 1.2%, p <0.001) and at 1 year (19.7% vs 4.4%, p <0.0001). After adjusting for clinical, demographic, and angiographic differences, renal disease remained an independent predictor of in-hospital (odds ratio 3.81, 95% confidence interval 1.70 to 8.58) and 1-year (risk ratio 2.46, 95% confidence interval 1.64 to 3.68) mortality. Renal disease conferred additional mortality risk in established high-risk clinical subgroups. In conclusion, after adjusting for a higher frequency of co-morbidities, renal disease remains a strong and independent predictor of increased in-hospital and 1-year mortality after PCI and is additive to other clinical markers of worse outcome.
Naidu
Srihari S
SS
Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Selzer
Faith
F
Jacobs
Alice
A
Faxon
David
D
Marks
David S
DS
Johnston
Janet
J
Detre
Katherine
K
Wilensky
Robert L
RL
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications* / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome