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)

被引:63
作者
Cardarelli, Francesca [1 ]
Bellasi, Antonio [1 ]
Ou, Fang-Shu [2 ]
Shaw, Leslee J. [1 ]
Veledar, Emir [1 ]
Roe, Matthew T. [2 ]
Morris, Douglas C. [1 ]
Peterson, Eric D. [2 ]
Klein, Lloyd W. [3 ]
Raggi, Paolo [1 ]
机构
[1] Emory Univ, Div Cardiol, Atlanta, GA 30322 USA
[2] Duke Univ, Duke Clin Res Inst, Durham, NC USA
[3] Rush Med Sch, Div Cardiol, Chicago, IL USA
关键词
RENAL-INSUFFICIENCY; OUTCOMES; COMPLICATIONS; ANGIOPLASTY; PREDICTOR; HEART;
D O I
10.1016/j.amjcard.2008.11.033
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Age and chronic kidney disease are major risk factors for poor cardiovascular outcome; however, renal function is often estimated on the basis of serum creatinine levels, and advanced renal impairment may be hidden behind near normal creatinine levels. We assessed the impact of estimated glomerular filtration rate (GFR) on in-hospital mortality in young (<65 years old), old (65 to 84 years old), and very old (>= 85 years old) patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction. The adjusted risk of death was calculated in 169,826 patients from the American College of Cardiology National Cardiovascular Data Registry undergoing primary PCI for acute myocardial infarction. Younger patients had fewer co-morbidities, higher estimated GFR, less frequent multivessel disease, and lower unadjusted mortality rates than older patients (p <0.0001 for all comparisons). However, the adjusted risk of in-hospital mortality for patients with severe renal insufficiency (estimated GFR <30 ml/min/1.73 m(2)) compared with those with normal renal function (estimated GFR >= 60 ml/min/1.73 m(2)) was higher in young patients (adjusted odds ratio = 7.58, 95% confidence interval 6.18 to 9.29) than old (adjusted odds ratio = 4.75, 95% confidence interval 4.14 to 5.45) and very old patients (adjusted odds ratio = 3.50, confidence interval 2.50 to 4.89). In conclusion, severe renal insufficiency is associated with a greater risk of in-hospital mortality in young than old and very old patients after primary PCI. Risk stratification for patients with acute myocardial infarction should incorporate an assessment of renal function with estimated GFR values rather than absolute serum creatinine levels as done in the currently utilized risk scoring algorithms. (C) 2009 Elsevier Inc. (Am J Cardiol 2009;103:766-771)
引用
收藏
页码:766 / 771
页数:6
相关论文
共 18 条
  • [1] The dilemma of success:: Percutaneous coronary interventions in patients ≥ 75 years of age -: Successful but associated with higher vascular complications and cardiac mortality
    Assali, AR
    Moustapha, A
    Sdringola, S
    Salloum, J
    Awadalla, H
    Saikia, S
    Ghani, M
    Hale, S
    Schroth, G
    Rosales, O
    Anderson, HV
    Smalling, RW
    [J]. CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2003, 59 (02) : 195 - 199
  • [2] The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions
    Best, PJM
    Lennon, R
    Ting, HH
    Bell, MR
    Rihal, CS
    Holmes, DR
    Berger, PB
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (07) : 1113 - 1119
  • [3] Impact of renal insufficiency on outcome after contemporary percutaneous coronary intervention
    Blackman, DJ
    Pinto, R
    Ross, JR
    Seidelin, PH
    Ing, D
    Jackevicius, C
    Mackie, K
    Chan, C
    Dzavik, V
    [J]. AMERICAN HEART JOURNAL, 2006, 151 (01) : 146 - 152
  • [4] K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification - Foreword
    Eknoyan, G
    Levin, NW
    [J]. AMERICAN JOURNAL OF KIDNEY DISEASES, 2002, 39 (02) : S14 - S266
  • [5] Comparison of outcomes of percutaneous coronary interventions in patients of three age groups (&lt;60, 60 to 80, and &gt;80 years) (from the New York State Angioplasty Registry)
    Feldman, Dmitriy N.
    Gade, Christopher L.
    Slotwiner, Alexander J.
    Parikh, Manish
    Bergman, Geoffrey
    Wong, S. Chiu
    Minutello, Robert M.
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 2006, 98 (10) : 1334 - 1339
  • [6] Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals
    Fried, LF
    Shlipak, MG
    Crump, C
    Bleyer, AJ
    Gottdiener, JS
    Kronmal, RA
    Kuller, LH
    Newman, AB
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (08) : 1364 - 1372
  • [7] Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization
    Go, AS
    Chertow, GM
    Fan, DJ
    McCulloch, CE
    Hsu, CY
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2004, 351 (13) : 1296 - 1305
  • [8] Clinical outcome following percutaneous coronary interventions in patients with chronic renal failure
    Gruberg, L
    Dangas, G
    Mehran, R
    Mintz, GS
    Kent, KM
    Pichard, AD
    Satler, LF
    Lansky, AJ
    Stone, GW
    Leon, MB
    [J]. CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2002, 55 (01) : 66 - 72
  • [9] Association of renal insufficiency with in-hospital mortality among Japanese patients with acute myocardial infarction undergoing percutaneous, coronary interventions
    Hirakawa, Yoshihisa
    Masuda, Yuichiro
    Kuzuya, Masafumi
    Iguchi, Akihisa
    Kimata, Takaya
    Uemura, Kazumasa
    [J]. INTERNATIONAL HEART JOURNAL, 2006, 47 (05) : 745 - 752
  • [10] Percutaneous coronary interventions in octogenarians in the American College of Cardiology-National Cardiovascular Data Registry - Development of a nomogram predictive of in-hospital mortality
    Klein, LW
    Block, P
    Brindis, RG
    McKay, CR
    McCallister, BD
    Wolk, M
    Weintraub, W
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 40 (03) : 394 - 402