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Clinical outcome following percutaneous coronary interventions in patients with chronic renal failure
Luis Gruberg1, George Dangas, Roxana Mehran
1Department of Cardiology, Rambam Medical Center, Haifa, Israel. gruberg67@hotmail.com
Insights
Percutaneous coronary intervention (PCI) in patients with chronic renal failure (CRF) or end-stage renal disease (ESRD) leads to significantly higher in-hospital and 1-year mortality rates compared to those with normal kidney function.
Area of Science:
- Cardiology
- Nephrology
- Clinical Outcomes Research
Background:
- Clinical outcomes of percutaneous coronary intervention (PCI) in patients with chronic renal failure (CRF) are not well-established.
- Renal dysfunction is a known risk factor for adverse cardiovascular events.
Purpose of the Study:
- To evaluate the in-hospital and 1-year clinical outcomes of patients with varying degrees of renal function undergoing PCI.
- To identify predictors of mortality in patients with impaired renal function post-PCI.
Main Methods:
- Retrospective analysis of 10,076 consecutive patients undergoing PCI between January 1994 and December 1997.
- Patients were categorized into three groups: end-stage renal disease (ESRD) on dialysis, CRF, and normal renal function.
- Multivariate analysis was used to identify independent correlates of mortality.
Main Results:
- Despite similar angiographic success rates (97%), in-hospital mortality was higher in patients with CRF (4.2%) and ESRD (6.8%) compared to those with normal renal function (0.9%).
- One-year mortality rates were significantly elevated for ESRD (48.8%) and CRF (25.7%) patients versus normal renal function (5.5%).
- Independent predictors of increased late mortality included ESRD, CRF, diabetes mellitus, and non-Q-wave myocardial infarction.
Conclusions:
- Percutaneous coronary intervention in patients with impaired renal function, including those with CRF and ESRD, is associated with significantly poorer in-hospital and 1-year survival.
- Renal function is a critical determinant of outcomes following PCI.
- Further research is needed to optimize PCI strategies for renal patients.
Abstract:
The clinical outcome of patients with chronic renal failure (CRF) who undergo percutaneous coronary intervention (PCI) has not been systematically evaluated in a large cohort of patients. We retrospectively analyzed the in-hospital and 1-year clinical outcomes of 10,076 consecutive patients who underwent PCI between January 1994 and December 1997. A total of 95 patients (0.9%) had end-stage renal disease (ESRD) on dialysis, 786 patients (7.8%) had CRF, and 9,125 patients (90.6%) had normal renal function. Despite an angiographic success rate of 97% in all three groups, in-hospital mortality was significantly higher among patients with renal disease, whether they were on dialysis or not, when compared to patients without renal dysfunction (6.8% vs. 4.2% vs. 0.9%; P < 0.0001). At 1-year follow-up, mortality rate was 48.8% for ESRD, 25.7% for patients with CRF, and 5.5%, for patients without renal dysfunction (P < 0.0001). By multivariate analysis, high left ventricular ejection fraction and creatinine clearance were associated with decreased late mortality (OR = 0.84 and 0.95; P < 0.0001), whereas ESRD (OR = 3.65; P = 0.0002), non-Q-wave myocardial infarction (OR = 2.21; P < 0.0001), diabetes mellitus (OR = 1.99; P < 0.0001), and CRF (OR = 1.74; P = 0.003) were independent correlates of increased late mortality. Therefore, PCI in patients with impaired renal function, whether on dialysis or not, is associated with poor in-hospital and 1-year survival.