Even moderate chronic renal failure is associated with impaired acute and long-term outcome after coronary angioplasty.
End-stage renal failure requiring maintenance haemodialysis is known to be a strong independent predictor of mortality and complications after coronary interventions. In contrast, data about the outcome of patients with moderate chronic renal failure is very limited and was therefore evaluated in this study in patients with coronary angioplasty (PTCA). This was a retrospective case-control study of 66 patients with moderate chronic renal failure who underwent PTCA, and who were matched to 66 PTCA patients with normal renal function and followed up by telephone interviews. In hospital, patients with renal failure suffered significantly more often from local complications (12.1 vs 0%, P = 0.004) and acute deterioration of renal function after PTCA (7.6 vs 0%, P = 0.023) than their matched controls. Angiographic success after PTCA was not significantly different (85 vs 83%, n.s.) as was the case with in-hospital mortality (6.1 vs 3.0%, n.s.). During follow up (100% complete), 18 patients (27.3%) with renal failure had died compared with seven controls (10.6%; OR 3.2, P = 0.015). Even if deaths from non-cardiac causes in three patients with renal failure were excluded, death after PTCA occurred significantly more often in the renal failure group (P = 0.015, log rang test). Multivariate analyses with stepwise logistic regression identified impaired left ventricular function (OR 2.24, 95%CI 1.33-3.77), elevated serum creatinine (OR 2.02, 95%CI 1.24-3.31) and smaller height (OR 0.91, 95%CI 0.86-0.98) to be independently associated with death. In conclusion, in this matched-pair study, patients with chronic renal failure suffered from more in-hospital complications and from markedly increased long-term mortality after PTCA.
Reinecke
Holger
H
Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany. reinech@uni-muenster.de
Regetmeier
Andrea
A
Matzkies
Fritz
F
Breithardt
Gunter
G
Schaefer
Roland M
RM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001827:Body Height; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications
D003404:Creatinine