Factors affecting long-term survival following renal artery stenting.
BACKGROUND
This study defines clinical variables at the time of renal artery stenting that may be predictors of long-term all-cause mortality.


METHODS
The data are derived from the single operator, single center, renal stent retrospective study (SOCRATES) and includes a review of 748 (336 men, 412 women) consecutive symptomatic patients with de novo atherosclerotic renal artery stenosis treated over an 11-year period. All patients had clinical indications for renal revascularization, including, but not limited to; suboptimal control of hypertension, chronic kidney disease, and cardiac disturbance syndromes. Clinical variables at the time of the index procedure were evaluated as predictors of all-cause mortality using multivariate analysis. Mortality data were derived from hospital records and formal queries of the State Department of Health and Human Services, Health and Vital Statistics Division database.


RESULTS
In-hospital, 30-day and 6-month mortality rates were 0.5, 2.0, and 6.3%, respectively. Overall patient survival at years 1, 5, and 10 was 91.2, 66.6, and 40.9%, respectively. Comorbid conditions, including chronic obstructive pulmonary disease and congestive heart failure, were independently associated with increased mortality. There were incremental changes in mortality in patients with baseline azotemia, [preprocedure serum creatinine (sCr) 1.5-2.09 mg/dL hazard ratio 1.52; sCr >2.5 mg/dL hazard ratio 3.39]. Therapy with lipid lowering agents offered a survival advantage (hazard ratio 0.69, P = 0.0.049); however, this study was not designed to evaluate a "protective effect" of lipid lowering medications.


CONCLUSIONS
Patients with chronic obstructive pulmonary disease and congestive heart failure undergoing renal artery stent revascularization have a poor long-term prognosis. Baseline azotemia is the strongest independent predictor of all cause mortality, with more than 70% of patients with marked azotemia (sCr >2.5) dead at 5 years.
Bates
Mark C
MC
Vascular Center of Excellence, Charleston Area Medical Center, Charleston, West Virginia, USA. m.henryilrmdt@wanadoo.fr
Campbell
John E
JE
Stone
Patrick A
PA
Jaff
Michael R
MR
Broce
Mike
M
Lavigne
Philip S
PS
D050197:Atherosclerosis / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D053099:Azotemia / Q000097:blood / Q000401:mortality*; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D009026:Mortality / Q000639:trends; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D012078:Renal Artery Obstruction / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014903:West Virginia / Q000453:epidemiology
D000960:Hypolipidemic Agents; D003404:Creatinine