[The impact of renal function on clinical outcomes of patients without chronic kidney disease undergoing coronary revascularization].
OBJECTIVE
This study determined the profile of renal insufficiency in patients without chronic kidney disease (CKD) undergoing coronary revascularization and elucidated the effect of renal insufficiency of different degrees on clinical outcomes after revascularization and examined whether the reasonable choice of the mode of revascularization could favourably influence prognosis.


METHODS
Patients undergoing coronary revascularization were grouped by estimated creatinine clearance (CrCl) (Group I, CrCl > or = 90 ml/min; Group II, 60 < or = CrCl < 90 ml/min; Group III, 30 < or = CrCl < 60 ml/min; Group IV, CrCl < 30 ml/min). We evaluated the relationship between the CrCl and the clinical outcomes of all of the patients.


RESULTS
The mean Scr level of 2896 patients was (80.0 +/- 35.4) micromol/L. There were 1035 patients (35.7%) in Group I, 1337 patients (46.2%) in Group II, 524 patients (18.1%) in Group III and no patient in Group IV. During hospitalization, significant difference was found among Group I-III on mortality (1.0%, 2.5% and 2.9%, P = 0.009) and major adverse cardiac cerebra events (MACCE) (1.4%, 3.5% and 4.6%, P = 0.001). Compared with the normal renal function group, there were significantly higher rate of mortality (2.5% vs. 1.0%, P = 0.007), new-onset myocardial infarction (1.0% vs. 0.2%, P = 0.018) and MACCE (3.5% vs. 1.4%, P = 0.002) in mild renal insufficiency (Grou II). During follow-up, there were significant difference among Group I-III on mortality (2.0%, 3.0% and 5.7%, P = 0.002), stroke (1.0%, 1.8% and 3.1%, P = 0.023) and MACCE (9.9%, 10.3% and 16.6%, P = 0.001). The independent risk factors for all-cause death in patients after revascularization were the mode of revascularization (OR 8.332, 95%CI 2.386 - 22.869, P = 0.001), age (OR 1.184, 95%CI 1.020 - 1.246, P = 0.001), and the level of CrCl (OR 0.503, 95%CI 0.186 - 0.988, P = 0.045). In patients with normal renal function and mild renal insufficiency, the all-cause mortality after PCI was significantly lower that than after CABG (both P < 0.01).


CONCLUSIONS
Renal insufficiency is common in patients without CKD undergoing coronary revascularization, even mild renal insufficiency is 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 University of Medical Sciences, Beijing 100029, China.
Ma
Chang-Sheng
CS
Nie
Shao-Ping
SP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000503:physiopathology* / Q000628:therapy*; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051437:Renal Insufficiency / Q000453:epidemiology*; D016896:Treatment Outcome
D003404:Creatinine