Coronary artery disease
Incidence, Predictors, and Outcomes of Post-Percutaneous Coronary Intervention Nephropathy in Patients With Diabetes Mellitus and Normal Baseline Serum Creatinine Levels

https://doi.org/10.1016/j.amjcard.2008.02.035Get rights and content

Diabetes mellitus is an independent predictor of nephropathy after percutaneous coronary intervention (PCI). The outcomes of patients with diabetes with normal baseline serum creatinine who undergo PCI remain underevaluated. The aim of the present study was to assess the incidence, outcomes, and correlates of post-PCI nephropathy in this subset. The study cohort consisted of 570 patients with diabetes with normal serum creatinine (≤1.3 mg/dl) who underwent PCI from August 2004 to December 2006. Patients aged >75 years and those presenting with either acute myocardial infarctions or cardiogenic shock were excluded. Post-PCI nephropathy was defined as a ≥25% increase in baseline creatinine. The study end points were post-PCI nephropathy and major adverse cardiac events at 6 months. Logistic regression was performed to identify independent predictors. Post-PCI nephropathy occurred in 70 patients (incidence 12.3%). These patients were more likely to be women (55.7% vs 35.5%, p = 0.001) and to have histories of congestive heart failure (24.2% vs 14.7%, p = 0.048). Entry-site complications (hematoma, pseudoaneurysm) and the need for blood transfusion (16.7% vs 1.7%, p <0.001) were more common in this group. In-hospital mortality (8.6% vs 0.2%, p <0.001) and length of stay (4.51 ± 5.2 vs 2.23 ± 2.9 days, p <0.001) were significantly higher in the group with post-PCI nephropathy. No study patient required dialysis. At 6 months, major adverse cardiac events were markedly higher in patients with post-PCI nephropathy (21.4% vs 6.0%, p <0.001), driven by death and revascularization. Independent predictors of post-PCI nephropathy were lower body mass index and blood transfusion. Post-PCI nephropathy independently predicted major adverse cardiac events (hazard ratio 4.3, 95% confidence interval 2.1 to 8.6, p <0.001). In conclusion, post-PCI nephropathy occurred in 12.3% of patients with diabetes with normal baseline serum creatinine and carried a significant detrimental impact on prognosis. The requirement for blood transfusions was the strongest correlate identified.

Section snippets

Patient population and study design

The study population was taken from a consecutive series of patients entered into a prospective registry who underwent PCI at our institution from August 2004 to December 2006. To be included in the study, patients were required to have diabetes mellitus requiring treatment with either oral hypoglycemic agents or insulin, have normal baseline creatinine levels (≤1.3 mg/dl), and have completed 6-month follow-up. Patients aged >75 years and those presenting with either acute myocardial infarction

Incidence

Post-PCI SCr increases occurred in 70 of 570 patients (12.3%).

Baseline patient characteristics

Clinical and procedural details are listed in Table 1, Table 2. Patients who developed SCr increases after PCI were more often women (55.7% vs 35.5%, p = 0.001) and had more frequent previous congestive heart failure (24.2% vs 14.7%, p = 0.05). Insulin-requiring diabetes mellitus was well matched between groups. Baseline creatinine was significantly lower in the group with SCr increases (0.84 ± 0.2 vs 0.97 ± 0.2 mg/dl, p <0.001;

Discussion

The present study draws attention to several important facets of the risk for post-PCI nephropathy. Post-PCI increases in SCr are not infrequent in patients with treated diabetes and normal baseline values. The study also confirmed the detrimental impact on prognosis of post-PCI nephropathy in this selected population. In addition, the predictors of post-PCI nephropathy (lower body mass index and blood transfusions) may identify those who are at increased risk and should be monitored more

Cited by (22)

  • Update and review of contrast-associated acute kidney injury

    2022, Disease-a-Month
    Citation Excerpt :

    Nonetheless, it has emerged in multivariate analysis as a risk factor inferring a fivefold increase in CA-AKI in one study.34 A retrospective cohort study of diabetic patients without CKD demonstrated 12.5% incidence of CA-AKI in this group.35 The primary prevention of CA-AKI is prudent caution in patients who are at highest risk for poor outcomes.

  • Optimizing Transradial Access: Radiation, Contrast, Access Site Crossover, and Ergonomics

    2020, Interventional Cardiology Clinics
    Citation Excerpt :

    These findings may be a result of avoiding the atheromatous aorta and renal vessels, thereby lessening the chance of atheroembolization. Alternatively, TRA also has the known benefit of less frequent transfusions and bleeding complications, both independent predictors of AKI.37,38 The radial approach continues to grow in prevalence in the United States year after year.

  • Effects of withdrawing vs continuing renin-angiotensin blockers on incidence of acute kidney injury in patients with renal insufficiency undergoing cardiac catheterization: Results from the Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker and Contrast Induced Nephropathy in Patients Receiving Cardiac Catheterization (CAPTAIN) trial

    2015, American Heart Journal
    Citation Excerpt :

    Increases in serum creatinine after coronary angiography have been associated with in-hospital mortality and increased length of stay in hospital.17,18 Postprocedural creatinine elevation has been identified as an independent predictor of major adverse cardiac events at 6 months after percutaneous coronary intervention.19 We also observed an improvement in GFR decline after angiography with holding ACEI/ARB.

  • Impact of contrast-induced acute kidney injury on outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

    2013, Cardiovascular Revascularization Medicine
    Citation Excerpt :

    Oral administration of angiotensin-converting enzyme inhibitors before admission is protecting the progression of renal dysfunction due to reduction of glomerular pressure; however, it contributes to an increased post-PCI sCr value in the emergent setting. Although some previously reported that AKI occurred even in patients with normal renal function (especially in diabetic patients) [13,14], this study recognized the importance of pre-procedural RI in the emergent setting. Patients with RI have a smaller number of residual nephrons, and these nephrons tend to be vulnerable to injury because of an increase in oxidative stress [5].

View all citing articles on Scopus
View full text