Coronary revascularization in patients with renal insufficiency: Restenosis rate and cardiovascular outcomes

Pinkau, Tobias; Mann, Johannes F.E.; Ndrepepa, Gjin; Mehilli, Julinda; Hadamitzky, Martin; Braun, Siegmund; Kastrati, Adnan; Schömig, Albert

doi:10.1053/j.ajkd.2004.05.045

Cited by 14 publications

(5 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is in accordance with previous studies where RI also has been found to be associated with a higher 30-days mortality and long term mortality [22-25]. Seyfarth et al [26] found an increase in adjusted hazard ratio after one year follow-up of 1.20 per 10-mL/min decrease in eGFR. In a study of Morel et al [27] STEMI and non-STEMI patients were found to have a higher 9-month all-cause mortality when diagnosed with renal disease.…”

Section: Discussionsupporting

confidence: 91%

Impact of renal insufficiency on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Sabroe

Thayssen

Antonsen

et al. 2014

BMC Cardiovasc Disord

View full text Add to dashboard Cite

BackgroundChronic kidney disease is associated with increased risk of mortality. We examined the impact of moderate and severe renal insufficiency (RI) on short- and long-term mortality among unselected patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).MethodsFrom January 1, 2002 to December 31, 2010 all patients with STEMI treated with primary PCI were identified. The hazard ratio (HR) for death was estimated using a Cox regression model, controlling for potential confounders. RI was defined as creatinine clearance (CrCl) < 60 mL/min (moderate RI: CrCl ≤30 < 60 mL/min and severe RI: CrCl < 30 mL/min).ResultsThe study cohort consisted of 4,116 patients of whom 898 (21.8%) had RI and 3,218 (78.2%) had a CrCl ≥ 60 mL/min. Compared to patients without RI, patients with RI were older, more often female and more likely to have diabetes mellitus, hypertension and to present with a higher Killip class.Among patients with a preserved kidney function and patients with RI, 30-day all-cause mortality was 3.5% vs. 20.9% (log-rank p < 0.001); 1-year all-cause mortality was 5.7% vs. 29.4% (log-rank p < 0.001); 5-year all-cause mortality was 13.4% vs. 47.4% (log-rank p < 0.001). Moderate and severe RI were associated with higher 1-year mortality compared to patients with a preserved renal function (CrCl ≤30 < 60 mL/min: adjusted HR 2.71 [95% CI 2.09-3.51], p < 0.001), and (CrCl < 30 mL/min: adjusted HR 7.09 [4.82-10.44], p < 0.001).ConclusionIn unselected STEMI patients treated with primary PCI, moderate and severe RI were associated with increased risk of mortality.

show abstract

Section: Discussionsupporting

confidence: 91%

Impact of renal insufficiency on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Sabroe

Thayssen

Antonsen

et al. 2014

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…They claimed that the decrease in renal function might represent a sensitive indicator of general microangiopathy induced by the presence of cardiovascular risk factors, particularly hypertension and diabetes. Pinkau et al 20 reported that patients with impaired renal function showed a rate of restenosis after PCI similar to that of patients with normal renal function, but there was a higher incidence of death or MI. They showed the existence of significant differences in baseline patient characteristics between patients with and without renal insufficiency and suggested that poor outcomes in the renal insufficiency patients could be explained by the multitude of comorbid conditions and worse preprocedural cardiac status.…”

Section: Discussionmentioning

confidence: 99%

Serum Creatinine on Admission Predicts Long-Term Mortality in Acute Myocardial Infarction Patients Undergoing Successful Primary Angioplasty

Yamaguchi

Kasanuki

Ishii

et al. 2007

Circ J

View full text Add to dashboard Cite

Background Data about the long-term mortality of acute myocardial infarction (AMI) patients with renal insufficiency who received sufficient early revascularization are scant, so the present study evaluated the impact of serum creatinine levels on the long-term mortality in patients with AMI undergoing successful primary percutaneous coronary intervention (PCI). Methods and ResultsThe Heart Institute of Japan Acute Myocardial Infarction (HIJAMI) registry has 3,021 consecutive AMI patients. Primary PCI was attempted in 1,451 patients and successful revascularization was obtained in 1,359 patients (93.6%). An elevated serum creatinine level, defined as creatinine ≥1.2 mg/dl, was observed in 216 patients (15.8%). Univariate analyses showed statistical differences between normal and elevated serum creatinine groups in age, gender, hypertension, previous myocardial infarction, number of diseased vessels and Killip class. During a median follow-up period of 39 [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] months, the event-free survival rate was lower in elevated creatinine group than normal creatinine group. Multivariate Cox proportional hazards model showed that serum creatinine level was an independent predictor of long-term mortality (adjusted hazard ratio 1.43 [95% confidence interval 1.03-1.99]). Conclusion The serum creatinine level on admission in patients with AMI predicts long-term mortality, even in those with successful primary PCI. (Circ J 2007; 71: 1354 -1359

show abstract

“…Pinkau et al reported that chronic renal insufficiency was not independently associated with clinical restenosis after coronary revascularization. 22 However, patients with chronic renal insufficiency showed increased mortality and frequency of acute MI at 1 year of follow-up. Also, the authors did not mention the pharmacological treatment and, therefore, it is uncertain whether the use of inhibitors of the renin-angiotensin system improves the prognosis of these patients.…”

Section: Discussionmentioning

confidence: 99%

Valsartan Cardio-Renal Protection in Patients Undergoing Coronary Angiography Complicated With Chronic Renal Insufficiency (VAL-CARP) Trial Rationale and Design

Ikeda

Nishimura

Kyo

et al. 2006

Circ J

View full text Add to dashboard Cite

Background Despite an increase in the frequency of coronary angiography (CAG) in Japan, the exact incidence of contrast-induced nephropathy (CIN) remains unknown in the Japanese population, especially in patients with chronic renal insufficiency. In addition, the nature of pharmacological interventions that would benefit the patients before or after procedures such as coronary bypass graft (CABG) and percutaneous coronary intervention (PCI) has not been fully investigated. Methods In the trial 500 patients with renal insufficiency (defined as a glomerular filtration rate (GFR) of between 89 and 30 ml·min -1 ·(1.73 m -2 ) following CAG will be randomly assigned to receive either valsartan, an angiotensin receptor blocker or angiotensin converting enzyme (ACE) inhibitor plus valsartan. 1 The primary end-point is a change in the GFR of patients, which will be followed up for 3 years, including following CABG surgery or PCI. The incidence of cardiac events as well as the adverse effects of pharmacological intervention will be evaluated. In addition, the incidence of renal artery stenosis at the time of CAG will be reported also; however, the patients with renal artery stenosis will be excluded from the present study. Conclusion The present study will provide data on: 1) the exact incidence and course of renal function of CIN after CAG; and 2) the comparative therapeutic benefit of pharmacological intervention with valsartan alone or with valsartan and an ACE inhibitor in combination in patients with coexisting coronary artery diseases and chronic renal insufficiency, regardless of whether they receive CABG or PCI. In addition to these studies, an estimate of the incidence of renal artery stenosis in these patients will be demonstrated. (Circ J 2006; 70: 548 -552)

show abstract

Coronary revascularization in patients with renal insufficiency: Restenosis rate and cardiovascular outcomes

Cited by 14 publications

References 38 publications

Impact of renal insufficiency on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Impact of renal insufficiency on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Serum Creatinine on Admission Predicts Long-Term Mortality in Acute Myocardial Infarction Patients Undergoing Successful Primary Angioplasty

Valsartan Cardio-Renal Protection in Patients Undergoing Coronary Angiography Complicated With Chronic Renal Insufficiency (VAL-CARP) Trial Rationale and Design

Contact Info

Product

Resources

About