Changes in renal function with percutaneous transluminal coronary angioplasty

There is concern about adverse effects on renal function in patients with p rolonged cardiac intervention procedures, when contrast media is used. To i nvestigate this further we studied changes in renal function in 104 patient s (79 male, 25 female; mean age 59.2, SD 9.8) undergoing routine elective p ercutaneous transluminal coronary angioplasty (PTCA), where 28 (27%) patien ts had concomitant stent implantation. There was associated diabetes in 15 patients (14%) and previous hypertension in 44 (blood pressure >160/90 mmHg , 44%). None of the patients were known to have congestive heart failure at the time of procedure or chronic renal failure (defined as serum creatinin e >200 pmol/l). There was no significant change in mean serum urea pre- and post-PTCA (mean change -0.04 mmol/l, paired t-test P=0.90). However, there was a small rise in serum creatinine pre- and post-PTCA of borderline sign ificance (mean change +5.8 mu mol/l, P=0.051). Of the whole cohort, 65 pati ents (63%) had a rise in mean serum creatinine, whilst 45 (43%) showed a ri se in serum urea levels. This deterioration in renal function was related t o a difference in the procedure duration, but there were no statistically s ignificant differences in mean age or volume of contrast media (lopamide 34 0) between patients with or without deteriotation in renal function. Patien ts with a rise in serum creatinine had lower baseline (pre-PTCA) serum urea and serum creatinine levels. In patients undergoing stent implantation, th ere was a higher quantity of contrast media, screening time and procedure d uration. There were no significant differences in age, pre-PTCA serum urea and creatinine levels, and mean change in serum urea or creatinine levels i n patients with and without stent usage. Whilst severe renal dysfunction fo llowing PTCA is uncommon, we suggest that some caution is necessary during PTCA or other cardiac interventions where more complex or prolonged procedu res necessitating large volumes of contrast media use. (C) 1999 Elsevier Sc ience Ireland Ltd. All rights reserved.