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Published on: January 28, 2020
Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention
Charanjit S Rihal1, Stephen C Textor, Diane E Grill
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Insights
Acute renal failure (ARF) after percutaneous coronary intervention (PCI) is uncommon but significantly increases mortality. Diabetic patients with baseline creatinine <2.0 mg/dL and all patients with baseline creatinine >2.0 mg/dL face higher ARF risks.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- The incidence and prognostic impact of acute renal failure (ARF) following percutaneous coronary intervention (PCI) in contemporary practice remain unclear.
- Understanding ARF risks is crucial for patient management and outcomes after PCI.
Purpose of the Study:
- To determine the incidence, risk factors, and prognostic implications of ARF after PCI.
- To identify patient subgroups at higher risk for ARF.
Main Methods:
- Retrospective analysis of the Mayo Clinic PCI registry.
- Inclusion of 7586 patients undergoing PCI.
- Definition of ARF as an increase in serum creatinine >0.5 mg/dL from baseline.
Main Results:
- ARF occurred in 3.3% of patients (254/7586).
- Risk factors included baseline serum creatinine, acute myocardial infarction, shock, and contrast volume.
- Diabetic patients with baseline creatinine <2.0 mg/dL had higher ARF risk; all patients with baseline creatinine >2.0 mg/dL were at high risk.
- ARF was associated with significantly increased in-hospital (22% vs 1.4%) and long-term mortality (1-year: 12.1% vs 3.7%; 5-year: 44.6% vs 14.5%).
Conclusions:
- The overall incidence of ARF post-PCI is low.
- Specific patient groups, including diabetics with baseline creatinine <2.0 mg/dL and all with baseline creatinine >2.0 mg/dL, are at elevated risk.
- ARF is a strong predictor of mortality during hospitalization and long-term follow-up.
Background:
In patients undergoing percutaneous coronary intervention (PCI) in the modern era, the incidence and prognostic implications of acute renal failure (ARF) are unknown.
Methods And Results:
With a retrospective analysis of the Mayo Clinic PCI registry, we determined the incidence of, risk factors for, and prognostic implications of ARF (defined as an increase in serum creatinine [Cr] >0.5 mg/dL from baseline) after PCI. Of 7586 patients, 254 (3.3%) experienced ARF. Among patients with baseline Cr <2.0, the risk of ARF was higher among diabetic than nondiabetic patients, whereas among those with a baseline Cr >2.0, all had a significant risk of ARF. In multivariate analysis, ARF was associated with baseline serum Cr, acute myocardial infarction, shock, and volume of contrast medium administered. Twenty-two percent of patients with ARF died during the index hospitalization compared with only 1.4% of patients without ARF (P<0.0001). After adjustment, ARF remained strongly associated with death. Among hospital survivors with ARF, 1- and 5-year estimated mortality rates were 12.1% and 44.6%, respectively, much greater than the 3.7% and 14.5% mortality rates in patients without ARF (P<0.0001).
Conclusions:
The overall incidence of ARF after PCI is low. Diabetic patients with baseline Cr values <2.0 mg/dL are at higher risk than nondiabetic patients, whereas all patients with a serum Cr >2.0 are at high risk for ARF. ARF was highly correlated with death during the index hospitalization and after dismissal.
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