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Published on: January 28, 2020
Preprocedural creatinine clearance and long term survivalafter successful coronary stenting
Karam Souibri1, Remy Morello, Sabine Fradin
1Department of Cardiology, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen cedex, Normandy, France.
Insights
Mild or severe renal dysfunction predicts death after coronary stenting. This highlights the need for prevention strategies in patients with coronary artery disease and kidney dysfunction.
Area of Science:
- Cardiology
- Nephrology
- Clinical Outcomes Research
Background:
- Severe renal dysfunction is linked to poor outcomes post-percutaneous coronary intervention (PCI).
- The impact of mild renal insufficiency on long-term results after coronary stenting is less understood.
Purpose of the Study:
- To assess long-term clinical outcomes in patients who underwent successful coronary stenting, specifically examining the influence of varying degrees of renal insufficiency.
Main Methods:
- A prospective observational study enrolled 1454 patients between 1997 and 1999.
- Patients were categorized by creatinine clearance: normal (>60 ml/mn), mild dysfunction (30-60 ml/mn), and severe dysfunction (<30 ml/mn).
- Clinical outcomes were compared across these groups, analyzing predictors of death.
Main Results:
- Patients with mild or severe renal dysfunction were older and had more severe coronary artery disease.
- Both mild (RR = 1.57 [1.03-2.40]) and severe (RR = 4.91 [2.63-9.15]) renal dysfunction were independent predictors of long-term death after stenting.
- Low ejection fraction and older age also predicted mortality.
Conclusions:
- Pre-procedural creatinine clearance is a significant independent predictor of long-term mortality in patients undergoing successful coronary stenting.
- Prevention strategies are crucial for patients with coronary artery disease and co-existing renal dysfunction.
Aim:
The clinical outcome of patients with severe renal dysfunction undergoing percutaneous coronary intervention (PCI) is poor. However little is known concerning the impact of mild renal insufficiency on long-term clinical outcomes after successful coronary stenting. The present prospective observational study was designed to evaluate long-term clinical outcomes in relation to renal insufficiency after successful coronary stenting.
Methods And Results:
A consecutive series of 1454 patients were enrolled between January 4th 1997 and January 4th 1999 Demographic and clinical characteristics and long term clinical outcome were compared for patients with normal creatinine clearance (>60 ml/mn), mild renal dysfunction (creatinine clearance rates 30-60 ml/mn) and severe renal dysfunction (creatinine clearance rates <30 ml/mn). Patients with moderate or severe renal dysfunction were older and with more severe coronary artery disease. Beyond conventional risk factors like age (RR = 1.72 [1.10-2.68] 95% CI ; p<0.018), or low left ventricular ejection fraction (RR = 2.60 [1.72-3.94] 95% CI ; p<0.001), severe (creatinine clearance rates < 30 ml/min) and mild (creatinine clearance 30-60 ml/min) renal dysfunction were also identified as strong independent predictors of death after successful coronary stenting (RR = 4.91 [2.63-9.15] 95% CI, p<0.001 and RR = 1.57 [1.03-2.40] 95% CI, p<0.034, respectively).
Conclusions:
In patients with successful coronary stenting, preprocedural creatinine clearance remains an important independent predictor of long term death. These data reinforce the importance of widespread application of prevention strategies especially in patients with coronary artery disease complicated by renal dysfunction.
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