Double jeopardy of renal insufficiency and anemia in patients undergoing percutaneous coronary interventions

• Published in: The American journal of cardiology Vol. 94; no. 1; pp. 30 - 34
• Main Authors: Gurm, Hitinder S, Lincoff, A.Michael, Kleiman, Neil S, Kereiakes, Dean J, Tcheng, James E, Aronow, Herbert D, Askari, Arman T, Brennan, Danielle M, Topol, Eric J
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2004; Elsevier; Elsevier Limited
• Subjects: Aged; Anemia - epidemiology; Anemias. Hemoglobinopathies; Angioplasty, Balloon, Coronary; Biological and medical sciences; Canada - epidemiology; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Diseases of red blood cells; Female; Glomerular Filtration Rate; Hematocrit; Hematologic and hematopoietic diseases; Humans; Intervention; Male; Medical sciences; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Proportional Hazards Models; Randomized Controlled Trials as Topic; Renal failure; Renal Insufficiency - epidemiology; Survival Analysis; Canada; Kidney disease; Human; Urinary system disease; Angioplasty; Anemia; Renal failure; Instrumentation therapy; Hemopathy; Circulatory system; Cardiology; Double; Phlebology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2004.03.025

Anemia and renal insufficiency impart an increased risk of mortality in patients with congestive heart failure. There is a paucity of data on the mortality hazard associated with anemia and renal insufficiency in patients undergoing percutaneous coronary intervention in the setting of contemporary practice. We analyzed the short- and long-term outcomes among patients enrolled in EPIC, EPILOG and EPISTENT trials according to degree of kidney dysfunction (glomerular filtration rate [GFR] <60, 60 to 75, and >75 ml/min/1.73 m 2) and by hematocrit (<35, 35 to 39 and 40). GFR was calculated as GFR = 186 × ( serum creatinine −1.154) × ( age −0.203) × 1.212 ( if black) or ×0.742 ( if female) . There were 20 deaths (3.2%) among 638 patients with a hematocrit of <35, 41 deaths among 2,066 patients (2.0%) with a hematocrit of 35 to 39, and 43 deaths in 3,618 patients (1.2%) with a hematocrit >40 at 6 months (p <0.001). Similarly, a significant increase in mortality was seen with lower GFR [33 of 1,168 (2.9%) at GFR <60, 33 of 1,766 (1.9%) at GFR 60 to 75 and 37 of 3,317 (1.1%) at GFR >75, p <0.001)]. Further, GFR and anemia independently and in combination predicted mortality at 3 years. Thus, renal insufficiency and anemia are significant independent and additive predictors of short- and long-term complications in patients undergoing percutaneous coronary intervention.