title: Renal insufficiency, bleeding and prescription of discharge medication in patients undergoing percutaneous coronary intervention in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry.
abstract: OBJECTIVE
  To establish the relationship between renal insufficiency, bleeding and prescription of cardiovascular medication.
  
  
  RESULTS
  This was a prospective, multi-center, cohort study of consecutive patients undergoing PCI during three NHLBI Dynamic Registry recruitment waves. Major and minor bleeding, access site bleeding and rates of prescription of cardiovascular medication at discharge were determined based on estimated glomerular filtration rate (eGFR). Renal insufficiency was an independent predictor of major adverse cardiovascular events (MACE). Bleeding events and access site bleeding requiring transfusion were significantly associated with degrees of renal insufficiency (p<0.001). There was an incremental decline in prescription of cardiovascular medication at discharge proportionate to the degree of renal impairment (aspirin, thienopyridine, statin, coumadin (overall p<0.001), beta blocker (overall p=0.003), ACE inhibitor (overall p=0.02). Bleeders were less likely to be discharged on a thienopyridine (95.4% versus 89.9% for bleeding, p<0.001 and 95.3% versus 87.9% for access site bleeding, p=0.005), but not aspirin (96.3% versus 96.2%, p=0.97 and 96.3% versus 93.6%, p=0.29 respectively). Failure to prescribe anti-platelet therapy at discharge was strongly associated with increased MACE at one year.
  
  
  CONCLUSIONS
  Renal insufficiency is associated with bleeding in patients undergoing PCI. Patients with renal insufficiency are less likely to receive recommended discharge pharmacotherapy.
authors.affiliation: Division of Cardiology, Boston Medical Center and Boston University School of Medicine; Division of Cardiology, St James's Hospital and Trinity College, Dublin, Ireland. Electronic address: andrew.maree@gmail.com.
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Maree
authors.affiliation: Division of Cardiology, Massachusetts General Hospital and Harvard Medical School.
authors.forename: Ronan J
authors.initials: RJ
authors.lastname: Margey
authors.affiliation: Department of Epidemiology, Division of Cardiology, University of Pittsburgh.
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.affiliation: Division of Cardiology, St James's Hospital and Trinity College, Dublin, Ireland.
authors.forename: Amrit
authors.initials: A
authors.lastname: Bajrangee
authors.affiliation: Division of Cardiology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine.
authors.forename: Hani
authors.initials: H
authors.lastname: Jneid
authors.affiliation: Division of Cardiology, University of Pittsburgh Medical Center.
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.affiliation: Division of Cardiology, University of Pittsburgh Medical Center.
authors.forename: Suresh R
authors.initials: SR
authors.lastname: Mulukutla
authors.affiliation: Division of Cardiology, The University of New Mexico School of Medicine.
authors.forename: Warren K
authors.initials: WK
authors.lastname: Laskey
authors.affiliation: Division of Cardiology, Boston Medical Center and Boston University School of Medicine.
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D002170:Canada; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018153:Czech Republic; D011307:Drug Prescriptions; D005260:Female; D005919:Glomerular Filtration Rate; D006470:Hemorrhage / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D054555:National Heart, Lung, and Blood Institute (U.S.); D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors
keywords: Antiplatelet; Cardiovascular medication; Percutaneous coronary intervention; Renal insufficiency