The impact of advanced chronic kidney disease on in-hospital mortality following percutaneous coronary intervention for acute myocardial infarction.
BACKGROUND
The impact of advanced chronic kidney disease (CKD) on the outcomes of patients undergoing percutaneous coronary intervention (PCI) in the acute phase of myocardial infarction is poorly understood. We assessed the impact of CKD (stages 3-5) on the in-hospital outcomes of patients undergoing PCI for acute myocardial infarction (AMI) in a statewide registry.


METHODS
This study evaluated all patients who underwent PCI in New York State between 1997 and 1999. Of the 9,015 patients, 94 (1%) had at least stage 3 CKD (serum creatinine for AMI > 2.5 mg/dL) and were not on dialysis. Patients with advanced CKD were compared with those without advanced CKD using univariate and multivariate methods. The primary outcome of interest was in-hospital mortality.


RESULTS
Patients with advanced CKD had a higher incidence of diabetes, hypertension, and peripheral vascular disease. Patients with advanced CKD presented more commonly with cardiogenic shock or heart failure. The unadjusted in-hospital mortality was 23.4% for patients with advanced CKD compared with 4.2% for patients without advanced CKD (P < 0.001). After adjusting for the increased comorbidity and high risk clinical features, advanced CKD remained an independent predictor of in-hospital mortality (odds ratio 2.4, 95% Confidence Interval, 1.002-5.804, P = 0.049).


CONCLUSIONS
Patients with AMI and advanced CKD who undergo PCI have more comorbidities and significantly worse in-hospital outcomes than patients without advanced CKD. Even after adjusting for these comorbidities, advanced CKD remains an independent predictor of increased in-hospital mortality.
Vasu
Sujethra
S
Department of Medicine, Division of Cardiovascular Medicine, State University of New York, Stony Brook University Medical Center, Stony Brook, New York 11794, USA.
Gruberg
Luis
L
Brown
David L
DL
D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D009518:New York / Q000453:epidemiology; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents
D003404:Creatinine