Background-In patients undergoing percutaneous coronary intervention (PCI) in the modern era, the incidence and prognostic implications of acute renal failure (ARF) are unknown. Methods and Results-With a retrospective analysis of the Mayo Clinic PCI registry, we determined the incidence of, risk factors for, and prognostic implications of ARF (defined as an increase in serum creatinine [Cr] Ͼ0.5 mg/dL from baseline) after PCI. Of 7586 patients, 254 (3.3%) experienced ARF. Among patients with baseline Cr Ͻ2.0, the risk of ARF was higher among diabetic than nondiabetic patients, whereas among those with a baseline Cr Ͼ2.0, all had a significant risk of ARF. In multivariate analysis, ARF was associated with baseline serum Cr, acute myocardial infarction, shock, and volume of contrast medium administered. Twenty-two percent of patients with ARF died during the index hospitalization compared with only 1.4% of patients without ARF (PϽ0.0001). After adjustment, ARF remained strongly associated with death. Among hospital survivors with ARF, 1-and 5-year estimated mortality rates were 12.1% and 44.6%, respectively, much greater than the 3.7% and 14.5% mortality rates in patients without ARF (PϽ0.0001). Conclusions-The overall incidence of ARF after PCI is low. Diabetic patients with baseline Cr values Ͻ2.0 mg/dL are at higher risk than nondiabetic patients, whereas all patients with a serum Cr Ͼ2.0 are at high risk for ARF. ARF was highly correlated with death during the index hospitalization and after dismissal.

Background Growing use of imaging procedures in the United States has raised concerns about exposure to low-dose ionizing radiation in the general population. Methods We identified 952,420 non-elderly adults in 5 healthcare markets across the United States between July 1, 2005 and December 31, 2007. Utilization data were used to determine cumulative effective doses of radiation from imaging procedures in millisieverts (mSv) and to calculate population-based rates of “moderate” (>3 to 20 mSv per year), “high” (>20 to 50 mSv per year) and “very-high” (>50 mSv per year) doses. Results During the study period, 655,613 (68.8%) individuals underwent at least 1 imaging procedure associated with radiation exposure. The mean effective dose from imaging procedures was 2.4 mSv per person per year (std dev, 6.0 mSv); however, a wide distribution was noted with a median effective dose of 0.1 mSv per person per year (interquartile range, 0.0 to 1.7). Overall, the annual rate for moderate effective doses in the study population was 193.8 per 1000 enrollees, while high and very-high doses occurred at annual rates of 18.6 per 1000 enrollees and 1.9 per 1000 enrollees, respectively. In general, effective doses of radiation from imaging procedures increased with advancing age and were higher in women. Computed tomography and nuclear medicine scans accounted for 75.4% of the total effective dose and 81.8% occurred in non-hospitalized settings. Conclusions Imaging procedures are an important source of ionizing radiation in the United States and can lead to high radiation doses in patients.

No abstract

No abstract

No abstract