Impact of renal function on morbidity and mortality after percutaneous aortocoronary saphenous vein graft intervention.

BACKGROUND Percutaneous coronary intervention in patients with chronic renal insufficiency (CRI) and native coronary artery disease is often problematic, marred by increased morbidity and mortality rates and a high incidence of restenosis and revascularization. However, little is known about the effect of CRI in patients who have undergone prior coronary artery bypass graft surgery and then undergo saphenous vein graft (SVG) intervention. METHODS We analyzed the inhospital and 1-year outcomes of 1265 consecutive patients with normal renal function and varying degrees of renal insufficiency who underwent percutaneous SVG intervention and divided them into 4 groups on the basis of the calculated creatinine clearance (CrCl): group 1, CrCl > or =70 mL per minute (n = 626); group 2, CrCl 50 to 69 mL per minute (n = 357); group 3, CrCl 30 to 49 mL per minute (n = 228); and group 4, CrCl <30 mL per minute (n = 54). Patients undergoing dialysis replacement therapy were excluded from the study. RESULTS Patients with lower CrCl more often were older, female, had diabetes mellitus, and had worse left ventricular function. Angiographic baseline characteristics were comparable among the 4 groups. Overall immediate procedural success was similar for all groups. Patients with a low CrCl had significantly higher inhospital overall and cardiac mortality rates (P <.001), including a significantly higher incidence of myocardial infarction, vascular complications, pulmonary edema, and renal function deterioration. At 1-year follow-up, the overall mortality rates remained significantly higher in patients with decreased CrCl, with an incremental rise in overall mortality rate associated with lower renal function (P <.001). CONCLUSIONS This study suggests that renal function is a primary determinate of short- and long-term survival in patients undergoing percutaneous SVG intervention and that there is a clear relationship between CrCl and cardiovascular outcome.

[1]  J. Dwight,et al.  Endothelial dysfunction in chronic renal failure: roles of lipoprotein oxidation and pro-inflammatory cytokines. , 2001, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[2]  S. Yusuf,et al.  Renal Insufficiency as a Predictor of Cardiovascular Outcomes and the Impact of Ramipril: The HOPE Randomized Trial , 2001, Annals of Internal Medicine.

[3]  I. Palacios,et al.  Effectiveness of and adverse events after percutaneous coronary intervention in patients with mild versus severe renal failure. , 2001, The American journal of cardiology.

[4]  C. Wanner,et al.  Dyslipidemia and renal disease: pathogenesis and clinical consequences , 2001, Current opinion in nephrology and hypertension.

[5]  G. Dangas,et al.  The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency. , 2000, Journal of the American College of Cardiology.

[6]  R. Choussat,et al.  Long-term clinical outcome after endoluminal reconstruction of diffusely degenerated saphenous vein grafts with less-shortening wallstents. , 2000, Journal of the American College of Cardiology.

[7]  A. Collins,et al.  Long-term outcome of dialysis patients in the United States with coronary revascularization procedures. , 1999, Kidney international.

[8]  E J Topol,et al.  Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. , 1998, Circulation.

[9]  Z. Massy,et al.  Incidence and risk factors of atherosclerotic cardiovascular accidents in predialysis chronic renal failure patients: a prospective study. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[10]  M. Leon,et al.  Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts. Saphenous Vein De Novo Trial Investigators. , 1997, The New England journal of medicine.

[11]  P. Serruys,et al.  Long-term clinical outcome after stent implantation in saphenous vein grafts. , 1996, Journal of the American College of Cardiology.

[12]  P. Teirstein,et al.  Immediate results and late outcomes after stent implantation in saphenous vein graft lesions: the multicenter U.S. Palmaz-Schatz stent experience. The Palmaz-Schatz Stent Study Group. , 1995, Journal of the American College of Cardiology.

[13]  E. Sowton,et al.  Percutaneous transluminal coronary angioplasty in patients with prior coronary artery bypass grafting: ten years' experience. , 1994, Catheterization and cardiovascular diagnosis.

[14]  D. Baim,et al.  Palmaz-Schatz stenting for treatment of focal vein graft stenosis: immediate results and long-term outcome. , 1994, Journal of the American College of Cardiology.

[15]  F. Grover,et al.  Percutaneous transluminal angioplasty of saphenous vein grafts for medically refractory unstable angina. , 1994, Journal of the American College of Cardiology.

[16]  J. Mayo,et al.  Coronary angioplasty after coronary bypass surgery: initial results and late outcome in 422 patients. , 1990, Journal of the American College of Cardiology.

[17]  P. Whitlow,et al.  Percutaneous transluminal angioplasty of saphenous vein graft stenosis: long-term follow-up. , 1989, Journal of the American College of Cardiology.

[18]  G. Dorros,et al.  Coronary angioplasty in patients with prior coronary artery bypass surgery: all prior coronary artery bypass surgery patients and patients more than 5 years after coronary bypass surgery. , 1989, Cardiology clinics.

[19]  M. Bourassa,et al.  Long-term fate of bypass grafts: the Coronary Artery Surgery Study (CASS) and Montreal Heart Institute experiences. , 1985, Circulation.

[20]  J. Pepper,et al.  Reoperation for angina after previous aortocoronary bypass surgery. , 1985, British heart journal.

[21]  M. Bourassa,et al.  Progression of atherosclerosis in coronary arteries and bypass grafts: ten years later. , 1984, The American journal of cardiology.

[22]  D. Cooley,et al.  Reoperation for recurrent coronary artery disease: causes, indications, and results in 168 patients. , 1979, Archives of surgery.

[23]  S. Epstein,et al.  Long-term anatomic fate of coronary-artery bypass grafts and functional status of patients five years after operation. , 1978, The New England journal of medicine.

[24]  T. Henry,et al.  Clinical outcomes of PTCA in chronic renal failure: a case-control study for comorbid features and evaluation of dialysis dependence. , 2001, The Journal of invasive cardiology.

[25]  P. Parfrey.  Is renal insufficiency an atherogenic state? Reflections on prevalence, incidence, and risk. , 2001, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[26]  F. Kronenberg,et al.  Lipoprotein(a) serum concentrations and apolipoprotein(a) phenotypes in mild and moderate renal failure. , 2000, Journal of the American Society of Nephrology : JASN.

[27]  Cockcroft Dw,et al.  Prediction of Creatinine Clearance from Serum Creatinine , 1976 .