title: Impact of acute renal failure following percutaneous coronary intervention on long-term mortality.
abstract: BACKGROUND
  Acute renal failure (ARF) following percutaneous coronary intervention (PCI) has been shown to be associated with a worse outcome. Whether this event should be considered as a marker of disease severity or an independent contributor to mortality is still unclear.
  
  
  METHODS
  In a multicenter, prospective cohort study we investigated the predictive variables and the impact of postprocedural ARF on 2-year all-cause mortality in 2860 consecutive patients (50% with stable angina and 50% with non-ST-elevation acute coronary syndromes) undergoing PCI. Serum creatinine determinations were made immediately before and 24 h after PCI. ARF was defined as an increase in serum creatinine of > or =0.5 mg/dl over baseline.
  
  
  RESULTS
  One hundred and six patients (3.7%) experienced ARF. At logistic regression analysis, ARF was associated with pre-existing low values of estimated glomerular filtration rate, reduced left ventricular ejection fraction, hypertension, and prior coronary bypass surgery. Mortality data at 2 years were available for all patients: 119 patients (4.16%) had died, 3.9% of those without and 11.3% of those with ARF (univariate hazard ratio 3.16; 95% confidence interval 1.68-5.94; P = 0.0004). At Cox regression analysis, the significant predictors of mortality were age, ejection fraction, preprocedural estimated glomerular filtration rate, PCI failure, atrial fibrillation, diabetes mellitus, and fluoroscopy time. In this comprehensive mortality model, ARF maintained a borderline statistical significance (hazard ratio 1.83, 95% confidence interval 0.98-3.44; P = 0.06).
  
  
  CONCLUSIONS
  ARF following PCI occurs almost exclusively in patients with chronic kidney disease or left ventricular dysfunction. These risk factors are also among the most powerful predictors of long-term mortality and are likely to explain most of the association between postprocedural ARF and long-term mortality. After correction for clinical determinants, however, postprocedural ARF maintains a clinically significant impact on mortality that must be taken into account for benefit vs. risk evaluation of PCI in individual patients.
authors.affiliation: De Gasperis' Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Roghi
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
authors.forename: Claudio
authors.initials: C
authors.lastname: Cavallini
authors.forename: Gustavo
authors.initials: G
authors.lastname: Arraiz
authors.forename: Luigi
authors.initials: L
authors.lastname: Angoli
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Bernardi
authors.forename: Mara
authors.initials: M
authors.lastname: Sansa
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Walter
authors.initials: W
authors.lastname: Pitscheider
authors.forename: Gian Battista
authors.initials: GB
authors.lastname: Danzi
authors.forename: Bernhard
authors.initials: B
authors.lastname: Reimers
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.forename: Martina
authors.initials: M
authors.lastname: Zaninotto
authors.forename: Diego
authors.initials: D
authors.lastname: Ardissino
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality; D000368:Aged; D000789:Angina, Unstable / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality
chemical_list: D015415:Biomarkers; D003404:Creatinine