The prognostic implications of further renal function deterioration within48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency

BACKGROUND Acute deterioration in renal function is a recognized complicati on after coronary angiography and intervention. OBJECTIVE The goal of this study was to determine the impact on acute and l ong-term mortality and morbidity of contrast-induced deterioration in renal function after coronary intervention. METHOD We studied 439 consecutive patients who had a baseline serum creatin ine greater than or equal to1.8 mg/dL (159.1 mu mol/L) who were not on dial ysis who underwent percutaneous coronary intervention in a tertiary referra l center. All patients were hydrated before the procedure, and almost all r eceived ioxaglate meglumine; 161 (37%) patients had an increase in serum cr eatinine greater than or equal to 25% within 48 h or required dialysis and 278 (63%) did not. In-hospital and out-of-hospital clinical events (death, myocardial infarction, repeat revascularization) were assessed by source do cumentation. RESULTS Independent predictors of renal function deterioration were left ve ntricular ejection fraction (p = 0.02) and contrast volume (p = 0.01). In-h ospital mortality was 14.9% for patients with further renal function deteri oration versus 4.9% for patients with no creatinine increase (P = 0.001); o ther complications were also more frequent. Thirty-one patients required he modialysis; their in-hospital mortality was 22.6%. Four patients were disch arged on chronic dialysis. The cumulative one-year mortality was 45.2% for those who required dialysis, 35.4% for those who did not require dialysis a nd 19.4% for patients with no creatinine increase (p = 0.001). Independent predictors of one-year mortality were creatinine elevation (p = 0.0001), ag e (p = 0.03) and vein graft lesion location (p = 0.08). CONCLUSIONS For patients with pre-existing renal insufficiency, renal funct ion deterioration after coronary intervention is a marker for poor outcomes . This is especially true for patients who require dialysis. (C) 2000 by th e American College of Cardiology.