August 26, 2008Catheterization and Cardiovascular Interventions
Transient and persistent renal dysfunction are predictors of survival after percutaneous coronary intervention: Insights from the Dartmouth Dynamic Registry
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).
Why the study?
Does transient or persistent renal dysfunction following PCI predict long-term mortality in patients undergoing PCI?
Population
7,763 consecutive patients undergoing percutaneous coronary intervention
Comparison
Transient renal dysfunction or persistent renal… vs No renal dysfunction
Design
Cohort
Follow-up
Median 3.2 years (mean 3.4), up to 7.5 years
Authors
Discussion
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Implication
Transient and persistent post-PCI creatinine rises were associated with 2–3-fold higher mortality; supports monitoring but leaves open causal confirmation.
Study Design
Type
Cohort (n=7,759)
Multicenter
No
Structured PICO
Does transient or persistent renal dysfunction following PCI predict long-term mortality in patients undergoing PCI?
P
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.
E
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)
C
Comparator
No renal dysfunction (<0.5 mg/dL increase in creatinine within 48 hr of the procedure)
O
Outcome
Mortality (survival at 1, 3.2, and 7.5 years)hard clinical
Main Result
Hazard Ratio: 3.13 (95% CI 2.44–4.02)
p-value: p=<0.001
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.
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.
Cite This Study
Brown et al. (2008) conducted a cohort in Percutaneous Coronary Intervention (n=7,759). Transient renal dysfunction vs. No renal dysfunction was evaluated on All-cause mortality (HR 3.13, 95% CI 2.44-4.02, p=<0.001). 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).