Transient and persistent renal dysfunction are predictors of survival after percutaneous coronary intervention: insights from the Dartmouth Dynamic Registry.
OBJECTIVE
We sought to determine if transient and persistent elevations in creatinine following percutaneous coronary intervention (PCI) resulted in poor survival.


BACKGROUND
Limited survival data exist that defines the natural survival history of transient and persistent renal dysfunction following interventional PCI cases.


METHODS
Data were collected prospectively on 7,856 consecutive patients undergoing PCI from January 1, 2000 to July 31, 2006. Ninety-three patients were excluded due to pre-PCI dialysis. Patients were stratified into three categories of renal dysfunction: no renal dysfunction from baseline (<0.5 mg/dL increase in creatinine within 48 hr of the procedure), transient renal dysfunction (> or =0.5 mg/dL increase in creatinine within 48 hr with return to normal within 2 weeks), and persistent renal dysfunction (> or =0.5 mg/dL increase in creatinine without returning to normal within 2 weeks of the procedure). Mortality was determined by comparing with the Social Security Death Master File.


RESULTS
Median survival was 3.2 years (mean 3.4). Renal dysfunction occurred in 250 patients (0.5 mg/dL increase in creatinine). Survival was significantly different between patients at 1, 3.2, and 7.5 years (P-value < 0.001): no renal dysfunction (95%, 88%, 75%), with transient (61%, 42%, 0%), and with persistent (58%, 44%, 36%) renal dysfunction. Patients with transient or persistent renal dysfunction had a twofold-threefold increased risk of 7.5-year mortality compared with patients with no renal dysfunction.


CONCLUSIONS
Both transient and persistent postprocedural renal dysfunction are prognostically significant for mortality during extended follow-up. Renal dysfunction should be closely monitored before and after PCI.
Brown
Jeremiah R
JR
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Malenka
David J
DJ
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
DeVries
James T
JT
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Robb
John F
JF
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Jayne
John E
JE
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Friedman
Bruce J
BJ
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Hettleman
Bruce D
BD
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Niles
Nathaniel W
NW
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Kaplan
Aaron V
AV
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Schoolwerth
Anton C
AC
Section of Nephrology and Hypertension, Department of Medicine, Dartmouth- Hitchcock Medical Center, Lebanon, NH.
Thompson
Craig A
CA
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D003287:Contrast Media / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009513:New Hampshire / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
D003287:Contrast Media; D003404:Creatinine