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Transient and persistent renal dysfunction are predictors of survival after percutaneous coronary intervention: Insights from the Dartmouth Dynamic Registry
Author(s) -
Brown Jeremiah R.,
Malenka David J.,
DeVries James T.,
Robb John F.,
Jayne John E.,
Friedman Bruce J.,
Hettleman Bruce D.,
Niles Nathaniel W.,
Kaplan Aaron V.,
Schoolwerth Anton C.,
Thompson Craig A.
Publication year - 2008
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21619
Subject(s) - medicine , creatinine , dialysis , conventional pci , renal function , percutaneous coronary intervention , cardiology , acute kidney injury , proportional hazards model , myocardial infarction
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 (<0.5 mg/dL increase in creatinine within 48 hr of the procedure), transient renal dysfunction (≥0.5 mg/dL increase in creatinine within 48 hr with return to normal within 2 weeks), and persistent renal dysfunction (≥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. © 2008 Wiley‐Liss, Inc.