The impact of advanced chronic kidney disease on in-hospital mortality following percutaneous coronary intervention for acute myocardial infarction.

The impact of advanced chronic kidney disease (CKD) on the outcomes of patients undergoing percutaneous coronary intervention (PCI) in the acute phase of myocardial infarction is poorly understood. We assessed the impact of CKD (stages 3-5) on the in-hospital outcomes of patients undergoing PCI for acute myocardial infarction (AMI) in a statewide registry. This study evaluated all patients who underwent PCI in New York State between 1997 and 1999. Of the 9,015 patients, 94 (1%) had at least stage 3 CKD (serum creatinine for AMI > 2.5 mg/dL) and were not on dialysis. Patients with advanced CKD were compared with those without advanced CKD using univariate and multivariate methods. The primary outcome of interest was in-hospital mortality. Patients with advanced CKD had a higher incidence of diabetes, hypertension, and peripheral vascular disease. Patients with advanced CKD presented more commonly with cardiogenic shock or heart failure. The unadjusted in-hospital mortality was 23.4% for patients with advanced CKD compared with 4.2% for patients without advanced CKD (P < 0.001). After adjusting for the increased comorbidity and high risk clinical features, advanced CKD remained an independent predictor of in-hospital mortality (odds ratio 2.4, 95% Confidence Interval, 1.002-5.804, P = 0.049). Patients with AMI and advanced CKD who undergo PCI have more comorbidities and significantly worse in-hospital outcomes than patients without advanced CKD. Even after adjusting for these comorbidities, advanced CKD remains an independent predictor of increased in-hospital mortality.

Vasu S ，Gruberg L ，Brown DL 《CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS》

Risk stratification according to the type of impaired renal function in patients with acute myocardial infarction treated with percutaneous coronary intervention.

Kowalczyk J ，Lenarczyk R ，Kowalski O ，Swiatkowski A ，Stabryła-Deska J ，Kurek T ，Honisz G ，Kukulski T ，Gasior M ，Kalarus Z ... -  《-》

Impact of severity of renal dysfunction on determinants of in-hospital mortality among patients undergoing percutaneous coronary intervention.

Chronic kidney disease (CKD) is a known prognostic indicator of poor outcomes following percutaneous coronary intervention (PCI) for coronary artery disease. However, it is unclear whether other predictors of mortality differ among patients with varying degrees of renal impairment. Thus, we aimed to identify determinants of in-hospital mortality which are specific to patients with preserved renal function, moderate CKD, or end stage renal disease (ESRD) on dialysis, undergoing PCI. The study population included 25,018 patients who underwent PCI between January 1, 2004, and December 31, 2007, at four New York State hospitals. The primary endpoint of the study was in-hospital mortality. A total of 474 (1.9%) patients had ESRD on dialysis, 6,596 (26.4%) had moderate CKD (GFR<60 ml/min/1.73 m(2) ), and 17,948 (71.7%) had preserved renal function (GFR>60 ml/min/1.73 m(2) ). Patients with ESRD and moderate CKD were older, more often male, and had higher rates of prior coronary revascularization, peripheral vascular disease, congestive heart failure, prior stroke, and diabetes than those with preserved function. All-cause in-hospital mortality rates were significantly higher in patients with ESRD and moderate CKD compared to patients with GFR >60 ml/min/1.73 m(2) (2.1% and 1.3%, respectively vs. 0.3%, p < 0.001). In multivariable analysis, ESRD (OR: 3.68, 95% CI 1.62-8.36) and moderate CKD (OR: 2.92, 95% CI 1.91-4.46) were independently associated with higher rates of in-hospital mortality. Independent predictors of mortality were markedly distinct in each group and included female gender and myocardial infarction within the past 72 hr in the ESRD group, versus left ventricular ejection fraction, peripheral vascular disease, congestive heart failure, emergency PCI, and absence of prior PCI in the moderate CKD group and age, prior bypass graft surgery, congestive heart failure, emergency PCI, and absence of prior myocardial infarction in patients with preserved renal function. Patients with moderate CKD or ESRD undergoing PCI have an approximately threefold increase in the risk of in-hospital mortality compared with patients with preserved renal function, with radically different mortality predictors existing for varying levels of renal function.

Parikh PB ，Jeremias A ，Naidu SS ，Brener SJ ，Lima F ，Shlofmitz RA ，Pappas T ，Marzo KP ，Gruberg L ... -  《-》

Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention.

Nikolsky E ，Mehran R ，Turcot D ，Aymong ED ，Mintz GS ，Lasic Z ，Lansky AJ ，Tsounias E ，Moses JW ，Stone GW ，Leon MB ，Dangas GD ... -  《-》

Combined impact of age and estimated glomerular filtration rate on in-hospital mortality after percutaneous coronary intervention for acute myocardial infarction (from the American College of Cardiology National Cardiovascular Data Registry).

Cardarelli F ，Bellasi A ，Ou FS ，Shaw LJ ，Veledar E ，Roe MT ，Morris DC ，Peterson ED ，Klein LW ，Raggi P ... -  《-》