Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Clinical Investigation
Prevalence and Impact of Renal Insufficiency on Clinical Outcomes of Patients Undergoing Coronary Revascularization
Qiang Zhang, Chang-Sheng Ma, Shao-Ping Nie, Xin Du, Qiang Lv, Jun-Ping Kang, Yin Zhang, Rong Hu, Chang-Qi Jia, Xin-Min Liu, Xiao-Hui Liu, Jian-Zeng Dong, Fang Chen, Yu-Jie Zhou, Shu-Zheng Lv, Fang-Jiong Huang, Cheng-Xiong Gu, Xue-Si Wu
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Keywords: Chronic kidney disease, Creatinine clearance, End-stage renal disease, Mortality, Revascularization
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2007 Volume 71 Issue 8 Pages 1299-1304

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Abstract

Background Patients with renal insufficiency are more likely to die after coronary revascularization, but mild renal insufficiency is neglected and little is known about its clinical effects. Methods and Results In the present study 3,025 patients grouped by estimated creatinine clearance (CrCl) were analyzed to evaluate the association between CrCl and clinical outcome. The mean serum creatinine was 1.0±0.4 mg/dl, with 4.3% above normal; in 65.8% CrCl was <90 ml/min. During hospitalization, there were significant differences in mortality among the groups stratified by CrCl (p<0.0001). During follow-up after hospital discharge, there were significant differences in mortality (p<0.0001), new-onset myocardial infarction (p=0.007), and stroke (p=0.032). In patients with severe renal insufficiency, the in-hospital and follow-up mortality reached 15.4% and 31.3%, respectively. The independent risk factors for all-cause death after revascularization were the mode of revascularization, age and the CrCl level. In patients with mild renal insufficiency or normal renal function, the all-cause mortality after percutaneous coronary intervention was significantly lower than that after CABG. Conclusions Renal insufficiency is not rare in patients undergoing coronary revascularization and in the present study even mild renal insufficiency correlated with adverse clinical outcomes after revascularization. In patients with normal renal function or mild renal insufficiency, the mode of revascularization might lead to a prognostic difference. (Circ J 2007; 71: 1299 - 1304)

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© 2007 THE JAPANESE CIRCULATION SOCIETY
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