title: Impact of chronic kidney disease on the incidence of peri-procedural myocardial injury in patients undergoing elective stent implantation.
abstract: BACKGROUND
  It is well known that chronic kidney disease is a strong independent predictor of adverse outcomes after percutaneous coronary intervention in patients with ischemic heart disease. Recently, peri-procedural myocardial injury has been associated with adverse cardiac events. The aim of this study was to investigate the relationship between renal function and peri-procedural myocardial injury in patients undergoing elective stent implantation.
  
  
  METHODS
  This study comprised 273 consecutive patients who underwent elective stent implantation. They were divided into two groups: estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m(2) and eGFR ≥60 mL/min/1.73m(2). Peri-procedural TnT levels higher than three times the normal limit were defined as peri-procedural myocardial injury.
  
  
  RESULTS
  Patients with eGFR <60 mL/min/1.73m(2) showed a higher incidence of peri-procedural myocardial injury compared to patients with eGFR ≥60 mL/min/1.73m(2) (4.3 versus 20.9%, P < 0.0001). Even after a multivariate adjustment, the eGFR level predicted peri-procedural myocardial injury [odds ratio 0.92, 95% confidence interval (CI): 0.89-0.95, P < 0.0001]. Total stent length was also an independent predictor of peri-procedural myocardial injury (odds ratio 1.09, 95% CI: 1.02-1.16, P = 0.009). Using a receiver-operating curve analysis, eGFR level of 62.1 mL/min/1.73m(2) (sensitivity 93.3%, specificity 57.2%) was the best value (area under the curve = 0.803) to maximize the power of eGFR levels in predicting peri-procedural myocardial injury.
  
  
  CONCLUSIONS
  Patients with eGFR <60 mL/min/1.73m(2) were strongly associated with peri-procedural myocardial injury after elective stent implantation. Therefore, eGFR may be a simple and convenient predictor of peri-procedural myocardial injury.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kumagai
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Amano
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Uetani
authors.forename: Bunichi
authors.initials: B
authors.lastname: Kato
authors.forename: Ken
authors.initials: K
authors.lastname: Harada
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Yoshida
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Ando
authors.forename: Ayako
authors.initials: A
authors.lastname: Kunimura
authors.forename: Yusaku
authors.initials: Y
authors.lastname: Shimbo
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Kitagawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Harada
authors.forename: Mutsuharu
authors.initials: M
authors.lastname: Hayashi
authors.forename: Daiji
authors.initials: D
authors.lastname: Yoshikawa
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Matsubara
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery*; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D012372:ROC Curve; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome