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Transient and persistent renal dysfunction are predictors of survival after percutaneous coronary intervention:
Jeremiah R Brown1, David J Malenka2, James T DeVries2
1The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Insights
Post-procedure renal dysfunction after percutaneous coronary intervention (PCI) significantly impacts survival. Both transient and persistent creatinine elevations indicate a higher mortality risk, necessitating close monitoring.
Area of Science:
- Cardiology
- Nephrology
- Clinical Outcomes
Background:
- Limited data exist on long-term survival following renal dysfunction after percutaneous coronary intervention (PCI).
- Understanding the prognostic significance of transient and persistent renal dysfunction post-PCI is crucial.
Purpose of the Study:
- To investigate the association between post-PCI creatinine elevations and patient survival.
- To determine if transient or persistent renal dysfunction impacts long-term mortality.
Main Methods:
- Prospective data collection from 7,856 patients undergoing PCI (2000-2006).
- Stratification into three groups: no renal dysfunction, transient renal dysfunction, and persistent renal dysfunction based on creatinine changes.
- Mortality assessment using the Social Security Death Master File.
Main Results:
- Renal dysfunction occurred in 250 patients.
- Patients with transient or persistent renal dysfunction showed significantly lower survival rates at 1, 3.2, and 7.5 years (P < 0.001).
- A twofold-threefold increased risk of 7.5-year mortality was observed in patients with post-PCI renal dysfunction.
Conclusions:
- Both transient and persistent post-PCI renal dysfunction are significant predictors of mortality.
- Close monitoring of renal function before and after PCI is recommended for improved patient outcomes.
Objectives:
We sought to determine if transient and persistent elevations in creatinine following percutaneous coronary intervention (PCI) resulted in poor survival.
Background:
Limited survival data exist that defines the natural survival history of transient and persistent renal dysfunction following interventional PCI cases.
Methods:
Data were collected prospectively on 7,856 consecutive patients undergoing PCI from January 1, 2000 to July 31, 2006. Ninety-three patients were excluded due to pre-PCI dialysis. Patients were stratified into three categories of renal dysfunction: no renal dysfunction from baseline (<0.5 mg/dL increase in creatinine within 48 hr of the procedure), transient renal dysfunction (> or =0.5 mg/dL increase in creatinine within 48 hr with return to normal within 2 weeks), and persistent renal dysfunction (> or =0.5 mg/dL increase in creatinine without returning to normal within 2 weeks of the procedure). Mortality was determined by comparing with the Social Security Death Master File.
Results:
Median survival was 3.2 years (mean 3.4). Renal dysfunction occurred in 250 patients (0.5 mg/dL increase in creatinine). Survival was significantly different between patients at 1, 3.2, and 7.5 years (P-value < 0.001): no renal dysfunction (95%, 88%, 75%), with transient (61%, 42%, 0%), and with persistent (58%, 44%, 36%) renal dysfunction. Patients with transient or persistent renal dysfunction had a twofold-threefold increased risk of 7.5-year mortality compared with patients with no renal dysfunction.
Conclusions:
Both transient and persistent postprocedural renal dysfunction are prognostically significant for mortality during extended follow-up. Renal dysfunction should be closely monitored before and after PCI.
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