title: Effects of staged versus ad hoc percutaneous coronary interventions on renal function-Is there a benefit to staging?
abstract: OBJECTIVE
  The purpose of this study is to determine whether ad hoc (same session) percutaneous coronary intervention, and staged (multiple session) percutaneous coronary intervention (PCI) have different renal outcomes.
  
  
  RESULTS
  This is a retrospective cohort study that compares the maximal decline in glomerular filtration rate (GFR) at various times points (3-6days, 1-4weeks, 4-12weeks) after either ad hoc or staged PCI. 115 patients undergoing staged PCI and 115 matched ad hoc PCI controls were included in the study. They were equivalent in baseline GFR, left ventricular ejection fraction and intra-procedural volume status based on LVEDP. The group undergoing staged PCI had greater cumulative fluoroscopy time, SYNTAX score and number of stents placed. Staged PCIs used less contrast per catheterization (155.0±5.6mL) but higher cumulative contrast dose (326.6±14.0mL) compared to ad hoc PCIs (193.4±7.2mL). Following intervention, there was a progressive decline in renal function that did not significantly differ between the ad hoc and staged groups. In the subgroup of patients with initial GFR ≤60cm3/min, staged PCI was associated with 2.6-fold greater decline in renal function 4-12weeks after the procedure compared to ad hoc. A propensity match analysis performed in patients with GFR ≤60cm3/min confirmed worse renal function in the staged group at 4-12weeks.
  
  
  CONCLUSIONS
  Staged PCI exposes patients to greater cumulative contrast agent loads. The decline in renal function observed in both groups did not differ significantly, however worse renal outcomes were observed in the staged PCI group with baseline GFR ≤60cm3/min.
authors.affiliation: Department of Cardiology, Lehigh Valley Hospital, Allentown, PA, United States. Electronic address: dr.mahekshah@yahoo.co.in.
authors.forename: Mahek
authors.initials: M
authors.lastname: Shah
authors.affiliation: Division of Cardiology, Einstein Medical Center, Philadelphia, PA, United States.
authors.forename: Deepakraj
authors.initials: D
authors.lastname: Gajanana
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States.
authors.forename: David S
authors.initials: DS
authors.lastname: Wheeler
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States.
authors.forename: Chitra
authors.initials: C
authors.lastname: Punjabi
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States.
authors.forename: Obiora
authors.initials: O
authors.lastname: Maludum
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States.
authors.forename: Kene
authors.initials: K
authors.lastname: Mezue
authors.affiliation: Division of Nephrology, University of Illinois, Chicago, IL, United States.
authors.forename: Edgar V
authors.initials: EV
authors.lastname: Lerma
authors.affiliation: Division of Cardiology, University of Illinois, Chicago, IL, United States.
authors.forename: Amer
authors.initials: A
authors.lastname: Ardati
authors.affiliation: Division of Cardiology, Einstein Medical Center, Philadelphia, PA, United States.
authors.forename: Abel
authors.initials: A
authors.lastname: Romero-Corral
authors.affiliation: Division of Cardiology, Einstein Medical Center, Philadelphia, PA, United States.
authors.forename: Christian
authors.initials: C
authors.lastname: Witzke
authors.affiliation: Department of Medicine, Einstein Medical Center, Philadelphia, PA, United States; Delaware Valley Nephrology and Hypertension Associates, Philadelphia, PA, United States.
authors.forename: Janani
authors.initials: J
authors.lastname: Rangaswami
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003287:Contrast Media / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D051437:Renal Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003287:Contrast Media
keywords: Ad hoc; Percutaneous coronary intervention; Renal failure; Staged