Impact of renal insufficiency on outcome after contemporary percutaneous coronary intervention

Blackman, Daniel J.; Pinto, Ruxandra; Ross, John; Seidelin, Peter H.; Ing, Douglas; Jackevicius, Cynthia A.; Mackie, Karen; Chan, Christopher T.; Džavík, Vladimir

doi:10.1016/j.ahj.2005.03.018

Cited by 86 publications

(66 citation statements)

References 35 publications

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“…3,10,20,21,[23][24][25][26][27][28] The Atherosclerosis Risk in Communities (ARIC) study 23 and the Second National Health and Nutrition Examination Survey (NHANES II) 3 demonstrated that a mild reduction in eGFR was a significant risk factor for both coronary vascular disease and all-cause mortality. The present study confirmed the prior studies by Anavekar et al in which reduced eGFR was independently associated with an increased risk of fatal and nonfatal adverse cardiovascular events after AMI.…”

Section: Discussionmentioning

confidence: 99%

Decreased glomerular filtration rate is a significant and independent risk for in-hospital mortality in Japanese patients with acute myocardial infarction: report from the Hokkaido acute myocardial infarction registry

et al. 2012

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on behalf of Hokkaido Acute Myocardial Infarction Registry InvestigatorsRenal dysfunction is a significant risk factor in the prognosis of patients with cardiovascular diseases. We sought to determine the relationship between estimated glomerular filtration rate (eGFR) values and in-hospital mortality in Japanese acute myocardial infarction (AMI) patients. A total of 2266 consecutive AMI patients admitted to 22 hospitals in Hokkaido were registered. The eGFR values were determined using the following equation: eGFR¼194Â(serum creatinine) À1.094 Â(age) À0.287 (Â0.739 if female). Patients were classified into four groups according to their eGFR values: X60 (n¼1304), 30-59 (n¼810), 15-29 (n¼87) and o15 ml min À1 per 1.73 m 2 (n¼65). A total of 110 patients (4.9%) died during hospitalization. The in-hospital mortality rate was significantly higher in patients with reduced eGFR values at 2.3, 5.4, 24.1 and 23.1% for eGFR values of X60, 30-59, 15-29, and o15 ml min À1 per 1.73 m 2 , respectively. The odds ratios for in-hospital all cause death were 8.26 (95% confidence interval (CI): 2.22-30.77) for eGFRo15 ml min À1 per 1.73 m 2 and 3.42 (95% CI: 1.01-11.61) for eGFR 15-29 ml min À1 per 1.73 m 2 compared with eGFR X60 ml min À1 per 1.73 m 2 . Similarly, the odds ratios for in-hospital cardiac death were 8.43 (95% CI: 1.82-39.05) for eGFRo15 ml min À1 per 1.73 m 2 and 5.47 (95% CI: 1.51-19.80) for eGFR 15-29 ml min À1 per 1.73 m 2 . In conclusion, the eGFR of o30 ml min À1 per 1.73 m 2 was a significant and independent risk for in-hospital mortality in abroad cohort of Japanese patients with AMI.

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Section: Discussionmentioning

confidence: 99%

Decreased glomerular filtration rate is a significant and independent risk for in-hospital mortality in Japanese patients with acute myocardial infarction: report from the Hokkaido acute myocardial infarction registry

et al. 2012

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“…A number of studies have reported the prognostic significance of eGFR in patients with CAD; [11][12][13][14][15][16][17][18] however, the majority of these studies were in Western countries and GFR was estimated by the MDRD equation or by creatinine clearance. Reports from Asian countries are very limited, possibly because of the lack of an accurate equation for eGFR in Asian populations.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies in which the prevalence of patients with eGFR o60 ml min À1 per 1.73 m 2 (that is, chronic kidney disease stage X3, according to the clinical guideline 21 ) was investigated in patients with CAD, showed that the prevalence of patients with eGFR o60 ml min À1 per 1.73 m 2 was 16-46% in Western countries. 11,12,[15][16][17][18] The MDRD equation or creatinine clearance was used in the majority of these studies. On the other hand, the prevalence of patients with eGFR o60 ml min À1 per 1.73 m 2 in Japanese patients with CAD was reported as 35 and 39% (Inaguma et al 13 and Furukawa et al 14 ) using MDRD equation with Japanese coefficient or creatinine clearance.…”

Section: Discussionmentioning

confidence: 99%

“…This study is the first report describing the long-term (410 years) prognostic significance of eGFR values in patients who underwent complete coronary revascularization. There are several reports in which patients with revascularization (PCI or CABG) were assessed; [11][12][13][14][15][16][17] however, the follow-up periods in the majority of these studies were p5 years and none of them described whether complete revascularization was achieved. It is important to emphasize the benefit of assessing data only in patients who had achieved complete revascularization, because the importance of completeness of revascularization during long-term follow-up period has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the prognostic significance of eGFR values has been studied in several subgroups such as patients with coronary artery disease (CAD), including patients who underwent percutaneous coronary intervention (PCI), [11][12][13][14] coronary artery bypass grafting (CABG) [15][16][17] or survivors of myocardial infarction. 18 However, the relationship between eGFR values and the long-term prognosis following complete coronary revascularization has not been established.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of glomerular filtration rate estimated by the Japanese equation among patients who underwent complete coronary revascularization

et al. 2010

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An equation that accurately estimates the glomerular filtration rate (GFR) in the Japanese population has been proposed; however, the prognostic significance of estimated GFR (eGFR) defined according to this equation has not been reported. In addition, the prognostic significance of eGFR during long-term follow-up after complete coronary revascularization remains unclear. We assessed the prognostic significance of eGFR values, estimated by the new Japanese equation, in a cohort of patients following complete coronary revascularization. We studied consecutive patients with complete revascularization from 1984 to 1992. Patients on dialysis were excluded. A novel Japanese equation was used to estimate the GFR: eGFR¼ 194Â(serum creatinine) À1.094 Â(age) À0.287 (Â0.739 if female). Multivariate Cox proportional hazards regression analyses were performed to determine all-cause and cardiac mortality. We analyzed data of 1809 patients, of whom 571 (31.6%) had an eGFR of X90 ml min À1 per 1.73 m 2 , 917 (50.7%) had an eGFR of 60-89 ml min À1 per 1.73 m 2 , 298 (16.5%) had an eGFR of 30-59 ml min À1 per 1.73 m 2 and 23 (1.3%) had an eGFR of o30 ml min À1 per 1.73 m 2 . During follow-up (11.4 ± 2.9 years), there were 397 (22.0%) all-cause and 123 (6.8%) cardiac deaths overall. Patients with an eGFR of 30-59 ml min À1 per 1.73 m 2 , and o30 ml min À1 per 1.73 m 2 revealed significantly greater risk of all-cause mortality than those with eGFR of X90 ml min À1 per 1.73 m 2 (hazard ratio (HR) 1.91, Po0.001, HR 3.35, Po0.001, respectively). Furthermore, incidence of cardiac death was higher in patients with an eGFR of 30-59 ml min À1 per 1.73 m 2 than those with an eGFR of X90 ml min À1 per 1.73 m 2 (HR 2.89, Po0.001). GFR as estimated using the new Japanese equation had a prognostic significance among patients with complete coronary revascularization.

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Quality of Care and Outcomes Among Patients With Acute Myocardial Infarction by Level of Kidney Function at Admission: Report From the Get With The Guidelines Coronary Artery Disease Program

Vasaiwala

Cannon

Fonarow

et al. 2012

Clinical Cardiology

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Background: Many patients admitted for acute myocardial infarction (AMI) have chronic renal insufficiency. We studied the impact of chronic renal insufficiency on mortality and quality of inpatient care for AMI from the American Heart Association's Get With The Guidelines-Coronary Artery Disease Program. Hypothesis: We hypothesized that mortality and quality of inpatient care would not vary with renal function. Methods: We examined in-hospital AMI performance measures by renal function based on glomerular filtration rate (GFR). Severity of renal insufficiency was categorized as normal (GFR ≥ 90 mL/min/1.73 m 2 ), mild (GFR 60-90 mL/min/1.73 m 2 ), moderate (GFR 30-60 mL/min/1.73 m 2 ), severe (GFR 15-30 mL/min/1.73 m 2 ), and kidney failure (GFR ≤ 15 mL/min/1.73 m 2 or dialysis). A total of 21721 patients from 291 sites were studied, with most data collected in 2008 to 2009. Multivariable regression analysis after adjusting for patient characteristics was performed and generalized estimating equations were used to account for within-hospital clustering. In-hospital mortality and quality of inpatient care were assessed. Results: Renal insufficiency was present in 82.0 percent of AMI patients. The adjusted odds ratio vs normal renal function for mortality increased with worsening renal function: 1.45 for mild renal insufficiency (95% confidence interval [CI]: 1.03-2.05, P = 0.03); 3.36 for moderate renal insufficiency (95% CI: 2.31-4.89, P < 0.0001); 5.43 for severe renal insufficiency (95% CI: 3.70-7.95, P < 0.0001); and 6.35 for kidney failure (95% CI: 4.48-9.01, P < 0.0001). Patients with renal insufficiency received less inpatient and discharge guideline-recommended therapy for AMI. Conclusions: Among AMI patients, mortality and guideline-recommended inpatient therapy correlated inversely with renal function. Adjusted mortality was equally poor among patients with severe renal dysfunction and on dialysis.Christopher P. Cannon, MD, has received research grants/support from Accumetrics, AstraZeneca, GlaxoSmithKline, Intekrin Therapeutics, Merck, and Takeda; is a member of the advisory board (funds donated to charity) of Bristol-Myers Squibb/Sanofi, Novartis, and Alnylam; received an honorarium for development of independent educational symposia from Pfizer and AstraZeneca; and is a clinical advisor

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Impact of renal insufficiency on outcome after contemporary percutaneous coronary intervention

Cited by 86 publications

References 35 publications

Decreased glomerular filtration rate is a significant and independent risk for in-hospital mortality in Japanese patients with acute myocardial infarction: report from the Hokkaido acute myocardial infarction registry

Decreased glomerular filtration rate is a significant and independent risk for in-hospital mortality in Japanese patients with acute myocardial infarction: report from the Hokkaido acute myocardial infarction registry

Prognostic significance of glomerular filtration rate estimated by the Japanese equation among patients who underwent complete coronary revascularization

Quality of Care and Outcomes Among Patients With Acute Myocardial Infarction by Level of Kidney Function at Admission: Report From the Get With The Guidelines Coronary Artery Disease Program

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