What is the clinical evidence from this study?

Study design: Cohort. Population: Percutaneous Coronary Intervention (n=7759). Intervention: Transient renal dysfunction vs. No renal dysfunction. Primary outcome: All-cause mortality (HR 3.13, 95% CI 2.44-4.02, p=<0.001).

August 26, 2008Catheterization and Cardiovascular Interventions121 citations

Transient and persistent renal dysfunction are predictors of survival after percutaneous coronary intervention: Insights from the Dartmouth Dynamic Registry

Q: What are the key findings of this study?

Transient and persistent renal dysfunction following percutaneous coronary intervention were associated with a significantly increased risk of long-term mortality compared to no renal dysfunction (transient HR 3.13, persistent HR 2.11).

JBJeremiah R. Brown DMDavid J. Malenka JDJames T. DeVries

Key Result

Transient and persistent renal dysfunction following percutaneous coronary intervention were associated with a significantly increased risk of long-term mortality compared to no renal dysfunction (transient HR 3.13, persistent HR 2.11).

Study Design

Type

Cohort (n=7,759)

Multicenter

Structured PICO

Does transient or persistent renal dysfunction following PCI predict long-term mortality in patients undergoing PCI?

Population

7,759 consecutive patients undergoing percutaneous coronary intervention, excluding those on pre-procedure dialysis, followed for up to 7.5 years to assess the impact of post-procedural renal dysfunction.

Exposure

Transient renal dysfunction (≥0.5 mg/dL increase in creatinine within 48 hr returning to normal within 2 weeks) or persistent renal dysfunction (≥0.5 mg/dL increase in creatinine not returning to normal within 2 weeks)

Comparator

No renal dysfunction (<0.5 mg/dL increase in creatinine within 48 hr of the procedure)

Outcome

Mortality (survival at 1, 3.2, and 7.5 years)hard clinical

Both transient and persistent renal dysfunction after PCI are strong predictors of long-term mortality, highlighting the need for close monitoring of renal function post-procedure.

Main Result

Hazard Ratio: 3.13 (95% CI 2.44–4.02)

p-value: p=<0.001

Limitations

Findings were derived from a single medical center and may not be generalizable to other geographic areas.
Unable to report on prophylactic treatments as they were not recorded in the registry.
Creatinine at baseline may not reflect a true baseline of renal function due to the presence of acute conditions such as myocardial infarction or cardiogenic shock.

Abstract

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 ( 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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