The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency.
By L. Gruberg, G. Mintz, R. Mehran, G. Dangas, A. Lansky, K. Kent, A. Pichard, L. Satler, M. Leon. Journal of the American College of Cardiology, 2000
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BACKGROUND Acute deterioration in renal function is a recognized complication after coronary angiography and intervention. OBJECTIVES The goal of this study was to determine the impact on acute and long-term mortality and morbidity of contrast-induced deterioration in renal function after coronary intervention. METHODS We studied 439 consecutive patients who had a baseline serum creatinine > or = 1.8 mg/dL (159.1 /micromol/L) who were not on dialysis who underwent percutaneous coronary intervention in a tertiary referral center. All patients were hydrated before the procedure, and almost all received ioxaglate meglumine; 161 (37%) patients had an increase in serum creatinine > or = 25% within 48 h or required dialysis and 278 (63%) did not. In-hospital and out-of-hospital clinical events (death, myocardial infarction, repeat revascularization) were assessed by source documentation. RESULTS Independent predictors of renal function deterioration were left ventricular ejection fraction (p = 0.02) and contrast volume (p = 0.01). In-hospital mortality was 14.9% for patients with further renal function deterioration versus 4.9% for patients with no creatinine increase (p = 0.001); other complications were also more frequent. Thirty-one patients required hemodialysis; their in-hospital mortality was 22.6%. Four patients were discharged on chronic dialysis. The cumulative one-year mortality was 45.2% for those who required dialysis, 35.4% for those who did not require dialysis and 19.4% for patients with no creatinine increase (p = 0.001). Independent predictors of one-year mortality were creatinine elevation (p = 0.0001), age (p = 0.03) and vein graft lesion location (p = 0.08). CONCLUSIONS For patients with pre-existing renal insufficiency, renal function deterioration after coronary intervention is a marker for poor outcomes. This is especially true for patients who require dialysis.
Subfields: Nephrology, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/3ac7401b4132920a6c8ed5f963ab996205c4ddd6
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Citations in the corpus
- Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury (2007, background): “However, according to data that have emerged since then, smaller changes in serum creatinine than those considered in the RIFLE criteria might be associated with adverse outcomes [13-18].”
- Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines (2011, background): “7% [22] in the general patient population to 7% in patients with CKD [31].”
- Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. (2005, unknown): “Previous bypass surgery 491 (22) 223 (21) 268 (23)”