Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification☆
Section snippets
Study sample
A database of patients who underwent coronary interventional procedures at William Beaumont Hospital (Royal Oak, Michigan) was tabulated. This database included demographic, clinical, and angiographic characteristics of 20,479 patients from 1993 to 2002 having 31,331 coronary interventions. For those patients who underwent ≥1 PCI (n = 10,162), the procedure associated with nephropathy was chosen for analysis; otherwise, the most recent procedure was used. Patients with any form of prior
Results
RCIN occurred in 2% (407 of 20,479) of our study population. The incidence of RCIN after PCI decreased from 2.8% in the derivation cohort (1993 to 1998) to 1.2% in the validation cohort (1999 to 2002; p <0.0001). The baseline characteristics of the study population are presented in Table 1. The mean increase in serum creatinine in patients without RCIN was 0.08 mg/dl (0.2 mg/dl, 90th percentile) versus 2.3 mg/dl (4.3 mg/dl; 90th percentile; p <0.0001) in patients with RCIN. Baseline increases
Discussion
We used the prospectively collected characteristics of a large, all-comer cohort of patients who underwent PCI to develop a time-insensitive clinical scoring system able to predict the development of RCIN. RCIN occurred in 2% of patients and was associated with a 15-fold increase in major adverse cardiac events compared with those patients without RCIN. The RCIN risk score uses the simple addition of 8 key variables to predict the risk of RCIN after PCI, thus providing excellent discrimination
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Dr. O'Neill received research funding from Abbott Pharmaceuticals (Abbott Park, Illinois) for the study of radiocontrast-induced nephropathy.