Transient and persistent renal dysfunction are predictors of survival after percutaneous coronary intervention: insights from the Dartmouth Dynamic Registry

Abstract

Objectives: We sought to determine if transient and persistent elevations in creatinine following percutaneous coronary intervention (PCI) resulted in poor survival.

Background: Limited survival data exist that defines the natural survival history of transient and persistent renal dysfunction following interventional PCI cases.

Methods: Data were collected prospectively on 7,856 consecutive patients undergoing PCI from January 1, 2000 to July 31, 2006. Ninety-three patients were excluded due to pre-PCI dialysis. Patients were stratified into three categories of renal dysfunction: no renal dysfunction from baseline (<0.5 mg/dL increase in creatinine within 48 hr of the procedure), transient renal dysfunction (> or =0.5 mg/dL increase in creatinine within 48 hr with return to normal within 2 weeks), and persistent renal dysfunction (> or =0.5 mg/dL increase in creatinine without returning to normal within 2 weeks of the procedure). Mortality was determined by comparing with the Social Security Death Master File.

Results: Median survival was 3.2 years (mean 3.4). Renal dysfunction occurred in 250 patients (0.5 mg/dL increase in creatinine). Survival was significantly different between patients at 1, 3.2, and 7.5 years (P-value < 0.001): no renal dysfunction (95%, 88%, 75%), with transient (61%, 42%, 0%), and with persistent (58%, 44%, 36%) renal dysfunction. Patients with transient or persistent renal dysfunction had a twofold-threefold increased risk of 7.5-year mortality compared with patients with no renal dysfunction.

Conclusions: Both transient and persistent postprocedural renal dysfunction are prognostically significant for mortality during extended follow-up. Renal dysfunction should be closely monitored before and after PCI.

Figure 1:

Adjusted Kaplan-Meier Survival Plot Stratified By Transient and Persistent Renal Dysfunction. Adjusted Kaplan-Meier survival curves, adjusted for age, sex, diabetes, prior myocardial infarction, ejection fraction<35%, non-elective priority, length of post-procedural hospitalization, morbid obesity, prior cardiac intervention, baseline eGFR<60 (mL/min/1.73m₂). Blue: no renal dysfunction (<0.5 mg/dL increase in creatinine from baseline). Red: transient renal dysfunction (_0.5 mg/dL increase in creatinine from baseline and creatinine returned to normal within 2 weeks). Green: persistent renal dysfunction (_0.5 mg/dL increase in creatinine from baseline and creatinine remained elevated within 2 weeks).