Prevalence and impact of renal insufficiency on clinical outcomes of patients undergoing coronary revascularization.
BACKGROUND
Patients with renal insufficiency are more likely to die after coronary revascularization, but mild renal insufficiency is neglected and little is known about its clinical effects.


RESULTS
In the present study 3,025 patients grouped by estimated creatinine clearance (CrCl) were analyzed to evaluate the association between CrCl and clinical outcome. The mean serum creatinine was 1.0+/-0.4 mg/dl, with 4.3% above normal; in 65.8% CrCl was <90 ml/min. During hospitalization, there were significant differences in mortality among the groups stratified by CrCl (p<0.0001). During follow-up after hospital discharge, there were significant differences in mortality (p<0.0001), new-onset myocardial infarction (p=0.007), and stroke (p=0.032). In patients with severe renal insufficiency, the in-hospital and follow-up mortality reached 15.4% and 31.3%, respectively. The independent risk factors for all-cause death after revascularization were the mode of revascularization, age and the CrCl level. In patients with mild renal insufficiency or normal renal function, the all-cause mortality after percutaneous coronary intervention was significantly lower than that after CABG.


CONCLUSIONS
Renal insufficiency is not rare in patients undergoing coronary revascularization and in the present study even mild renal insufficiency correlated with adverse clinical outcomes after revascularization. In patients with normal renal function or mild renal insufficiency, the mode of revascularization might lead to a prognostic difference.
Zhang
Qiang
Q
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China.
Ma
Chang-Sheng
CS
Nie
Shao-Ping
SP
Du
Xin
X
Lv
Qiang
Q
Kang
Jun-Ping
JP
Zhang
Yin
Y
Hu
Rong
R
Jia
Chang-Qi
CQ
Liu
Xin-Min
XM
Liu
Xiao-Hui
XH
Dong
Jian-Zeng
JZ
Chen
Fang
F
Zhou
Yu-Jie
YJ
Lv
Shu-Zheng
SZ
Huang
Fang-Jiong
FJ
Gu
Cheng-Xiong
CX
Wu
Xue-Si
XS
D000328:Adult; D000368:Aged; D003401:Creatine; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality*; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
D003401:Creatine