Clinical Studies
Acute Renal Failure After Coronary Intervention: Incidence, Risk Factors, and Relationship to Mortality

This work was presented in part at the Second Annual Scientific Session of the Council on Geriatric Cardiology, March 23, 1996, and at the 45th Annual Scientific Session of the American College of Cardiology, March 24–27, 1996, Orlando, Florida.
https://doi.org/10.1016/S0002-9343(97)00150-2Get rights and content

Abstract

PURPOSE: This study set out to define the incidence, predictors, and mortality related to acute renal failure (ARF) and acute renal failure requiring dialysis (ARFD) after coronary intervention.

PATIENTS AND METHODS: Derivation-validation set methods were used in 1,826 consecutive patients undergoing coronary intervention with evaluation of baseline creatinine clearance (CrCl), diabetic status, contrast exposure, postprocedure creatinine, ARF, ARFD, in-hospital mortality, and long-term survival (derivation set). Multiple logistic regression was used to derive the prior probability of ARFD in a second set of 1,869 consecutive patients (validation set).

RESULTS: The incidence of ARF and ARFD was 144.6/1,000 and 7.7/1,000 cases respectively. The cutoff dose of contrast below which there was no ARFD was 100 mL. No patient with a CrCl > 47 mL/min developed ARFD. These thresholds were confirmed in the validation set. Multivariate analysis found CrCl [odds ratio (OR) = 0.83, 95% confidence interval (CI) 0.77 to 0.89, P <0.00001], diabetes (OR = 5.47, 95% CI 1.40 to 21.32, P = 0.01), and contrast dose (OR = 1.008, 95% CI 1.002 to 1.013, P = 0.01) to be independent predictors of ARFD. Patients in the validation set who underwent dialysis had a predicted prior probability of ARFD of between 0.07 and 0.73. The in-hospital mortality for those who developed ARFD was 35.7% and the 2-year survival was 18.8%.

CONCLUSION: The occurrence of ARFD after coronary intervention is rare (<1%) but is associated with high in-hospital mortality and poor long-term survival. Individual patient risk can be estimated from calculated CrCl, diabetic status, and expected contrast dose prior to a proposed coronary intervention.

Section snippets

Study Sample

This study was approved by the Human Investigations Committee at William Beaumont Hospital, a 929 bed tertiary care center. A total of 2,206 consecutive coronary interventional procedures (balloon angioplasty, atherectomy, stenting) at our institution were screened from December 1993 to August 1994. Twenty-four patients previously on dialysis were excluded. Repeated procedures within the study period (n = 356) were also excluded. The final cohort of 1,826 had one procedure per patient

Results

Baseline characteristics of the derivation set subdivided by diabetic status are listed in Table 1. The contrast agents used were diatrizoate (Hypaque) in 1,002 patients (54.9%), ioxaglate meglumine (Hexabrix) in 601 (33.0%), and both in 223 (12.0%). Doses of contrast ranged from 24.0 mL to 835.0 mL. Preprocedure serum creatinine values were available in 1,799 cases (98.5%) and at least one postprocedure creatinine was available in 1790 (98.0%). In no case were both pre- and postprocedure

Discussion

Ten million intravascular contrast procedures are performed in the United States per year, 400,000 of which are coronary interventions.43, 47The present study has outlined, in a large cohort of coronary intervention patients, the risks of ARF and ARFD in terms of absolute and validated prospective probabilities. Furthermore, the fatal associations between ARF and ARFD in terms of short-term mortality and long-term survival have been demonstrated. These associations have been found similarly in

Acknowledgements

We are indebted to Gerald C. Timmis, MD, for his support and critical review of this work.

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