Double jeopardy of renal insufficiency and anemia in patients undergoing percutaneous coronary interventions.
Anemia and renal insufficiency impart an increased risk of mortality in patients with congestive heart failure. There is a paucity of data on the mortality hazard associated with anemia and renal insufficiency in patients undergoing percutaneous coronary intervention in the setting of contemporary practice. We analyzed the short- and long-term outcomes among patients enrolled in EPIC, EPILOG and EPISTENT trials according to degree of kidney dysfunction (glomerular filtration rate [GFR] <60, 60 to 75, and >75 ml/min/1.73 m2) and by hematocrit (<35, 35 to 39 and 40). GFR was calculated as GFR = 186 x (serum creatinine-1.154) x (age-0.203) x 1.212 (if black) or x 0.742 (if female). There were 20 deaths (3.2%) among 638 patients with a hematocrit of <35, 41 deaths among 2,066 patients (2.0%) with a hematocrit of 35 to 39, and 43 deaths in 3,618 patients (1.2%) with a hematocrit >40 at 6 months (p <0.001). Similarly, a significant increase in mortality was seen with lower GFR [33 of 1,168 (2.9%) at GFR <60, 33 of 1,766 (1.9%) at GFR 60 to 75 and 37 of 3,317 (1.1%) at GFR >75, p <0.001)]. Further, GFR and anemia independently and in combination predicted mortality at 3 years. Thus, renal insufficiency and anemia are significant independent and additive predictors of short- and long-term complications in patients undergoing percutaneous coronary intervention.
Gurm
Hitinder S
HS
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, 44195, USA.
Lincoff
A Michael
AM
Kleiman
Neil S
NS
Kereiakes
Dean J
DJ
Tcheng
James E
JE
Aronow
Herbert D
HD
Askari
Arman T
AT
Brennan
Danielle M
DM
Topol
Eric J
EJ
D000368:Aged; D000740:Anemia / Q000453:epidemiology*; D015906:Angioplasty, Balloon, Coronary; D002170:Canada / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000453:epidemiology*; D016019:Survival Analysis