title: Double jeopardy of renal insufficiency and anemia in patients undergoing percutaneous coronary interventions.
abstract: 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.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, 44195, USA.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.forename: A Michael
authors.initials: AM
authors.lastname: Lincoff
authors.forename: Neil S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Kereiakes
authors.forename: James E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.forename: Arman T
authors.initials: AT
authors.lastname: Askari
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Brennan
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: 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