title: Impact of renal insufficiency on outcome after contemporary percutaneous coronary intervention.
abstract: BACKGROUND
  End-stage renal failure is associated with poor outcomes, including increased mortality, after percutaneous coronary intervention (PCI). The effect of milder degrees of renal insufficiency (RI) is less clear, especially with routine stenting and glycoprotein IIb/IIIa inhibitor therapy, which may be of particular benefit in patients with RI.
  
  
  METHODS
  Clinical, angiographic, procedural, and outcome variables of 7769 consecutive patients who underwent PCI between April 2000 and July 2004 were entered into a prospective database. Inhospital mortality and morbidity were calculated according to baseline creatinine clearance. Simple and multiple logistic regression analyses were performed to determine independent predictors of mortality.
  
  
  RESULTS
  Baseline creatinine clearance was available in 6840 patients. It was normal (> 80 mL/min) in 3474; 1670 had mild RI (61-80 mL/min), 1111 moderate RI (41-60 mL/min), and 585 severe RI (< or = 40 mL/min). Major adverse cardiac events (MACE) (death/myocardial infarction/revascularization) increased substantially with worsening renal function (2.4% vs 3.0% vs 4.8% vs 9.7%, P < .0001), as did mortality (0.3% vs 0.7% vs 1.5% vs 6.0%, P < .0001). Multiple logistic regression analysis identified moderate RI and severe RI as independent predictors of mortality (odds ratio [OR] 3.9, P < .001; OR 12.7, P < .0001, respectively) and morbidity (MACE) (OR 1.5, P < .05; OR 2.5, P < .0001, respectively). Mild RI trended to increase the risk of mortality but did not reach statistical significance as an independent predictor of inhospital death on multiple regression analysis (OR 2.1, P = .1) and did not increase the risk of MACE (OR 1.1, P = .6).
  
  
  CONCLUSIONS
  Despite routine stenting and glycoprotein IIb/IIIa inhibitor therapy, RI remains an independent predictor of increased morbidity, and particularly mortality, after PCI. However, the adverse effect of truly mild RI on outcome is limited.
authors.affiliation: Interventional Cardiology Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackman
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Pinto
authors.forename: John R
authors.initials: JR
authors.lastname: Ross
authors.forename: Peter H
authors.initials: PH
authors.lastname: Seidelin
authors.forename: Douglas
authors.initials: D
authors.lastname: Ing
authors.forename: Cynthia
authors.initials: C
authors.lastname: Jackevicius
authors.forename: Karen
authors.initials: K
authors.lastname: Mackie
authors.forename: Christopher
authors.initials: C
authors.lastname: Chan
authors.forename: Vladimir
authors.initials: V
authors.lastname: Dzavik
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000150:complications / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications*; D012307:Risk Factors; D016896:Treatment Outcome