Association of chronic renal insufficiency with in-hospital outcomes after percutaneous coronary intervention

Tanush Gupta, Neha Paul, Dhaval Kolte, Prakash Harikrishnan, Sahil Khera, Wilbert S. Aronow, Marjan Mujib, Chandrasekar Palaniswamy, Sachin Sule, Diwakar Jain, Ali Ahmed, Howard A. Cooper, William H. Frishman, Deepak L. Bhatt, Gregg C. Fonarow, Julio A. Panza

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The association of chronic renal insufficiency with outcomes after percutaneous coronary intervention (PCI) in the current era of drug-eluting stents and modern antithrombotic therapy has not been well characterized.

METHODS AND RESULTS: We queried the 2007-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent PCI. Multivariable logistic regression was used to compare in-hospital outcomes among patients with chronic kidney disease (CKD), patients with end-stage renal disease (ESRD), and those without CKD or ESRD. Of 3 187 404 patients who underwent PCI, 89% had no CKD/ESRD; 8.6% had CKD; and 2.4% had ESRD. Compared to patients with no CKD/ESRD, patients with CKD and patients with ESRD had higher in-hospital mortality (1.4% versus 2.7% versus 4.4%, respectively; adjusted odds ratio for CKD 1.15, 95% CI 1.12 to 1.19, P<0.001; adjusted odds ratio for ESRD 2.29, 95% CI 2.19 to 2.40, P<0.001), higher incidence of postprocedure hemorrhage (3.5% versus 5.4% versus 6.0%, respectively; adjusted odds ratio for CKD 1.21, 95% CI 1.18 to 1.23, P<0.001; adjusted odds ratio for ESRD 1.27, 95% CI 1.23 to 1.32, P<0.001), longer average length of stay (2.9 days versus 5.0 days versus 6.4 days, respectively; P<0.001), and higher average total hospital charges ($60 526 versus $77 324 versus $97 102, respectively; P<0.001). Similar results were seen in subgroups of patients undergoing PCI for acute coronary syndrome or stable ischemic heart disease.

CONCLUSIONS: In patients undergoing PCI, chronic renal insufficiency is associated with higher in-hospital mortality, higher postprocedure hemorrhage, longer average length of stay, and higher average hospital charges.

Original languageEnglish (US)
Pages (from-to)e002069
JournalJournal of the American Heart Association
Volume4
Issue number6
DOIs
StatePublished - Jun 16 2015
Externally publishedYes

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Percutaneous Coronary Intervention
Chronic Renal Insufficiency
Chronic Kidney Failure
Odds Ratio
Hospital Charges
Hospital Mortality
Length of Stay
Hemorrhage
Drug-Eluting Stents
Acute Coronary Syndrome
Myocardial Ischemia
Inpatients
Logistic Models
Databases
Incidence

Keywords

  • chronic kidney disease
  • end‐stage renal disease
  • in‐hospital mortality
  • percutaneous coronary intervention
  • postprocedure hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of chronic renal insufficiency with in-hospital outcomes after percutaneous coronary intervention. / Gupta, Tanush; Paul, Neha; Kolte, Dhaval; Harikrishnan, Prakash; Khera, Sahil; Aronow, Wilbert S.; Mujib, Marjan; Palaniswamy, Chandrasekar; Sule, Sachin; Jain, Diwakar; Ahmed, Ali; Cooper, Howard A.; Frishman, William H.; Bhatt, Deepak L.; Fonarow, Gregg C.; Panza, Julio A.

In: Journal of the American Heart Association, Vol. 4, No. 6, 16.06.2015, p. e002069.

Research output: Contribution to journalArticle

Gupta, T, Paul, N, Kolte, D, Harikrishnan, P, Khera, S, Aronow, WS, Mujib, M, Palaniswamy, C, Sule, S, Jain, D, Ahmed, A, Cooper, HA, Frishman, WH, Bhatt, DL, Fonarow, GC & Panza, JA 2015, 'Association of chronic renal insufficiency with in-hospital outcomes after percutaneous coronary intervention', Journal of the American Heart Association, vol. 4, no. 6, pp. e002069. https://doi.org/10.1161/JAHA.115.002069
Gupta, Tanush ; Paul, Neha ; Kolte, Dhaval ; Harikrishnan, Prakash ; Khera, Sahil ; Aronow, Wilbert S. ; Mujib, Marjan ; Palaniswamy, Chandrasekar ; Sule, Sachin ; Jain, Diwakar ; Ahmed, Ali ; Cooper, Howard A. ; Frishman, William H. ; Bhatt, Deepak L. ; Fonarow, Gregg C. ; Panza, Julio A. / Association of chronic renal insufficiency with in-hospital outcomes after percutaneous coronary intervention. In: Journal of the American Heart Association. 2015 ; Vol. 4, No. 6. pp. e002069.
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AU - Gupta, Tanush

AU - Paul, Neha

AU - Kolte, Dhaval

AU - Harikrishnan, Prakash

AU - Khera, Sahil

AU - Aronow, Wilbert S.

AU - Mujib, Marjan

AU - Palaniswamy, Chandrasekar

AU - Sule, Sachin

AU - Jain, Diwakar

AU - Ahmed, Ali

AU - Cooper, Howard A.

AU - Frishman, William H.

AU - Bhatt, Deepak L.

AU - Fonarow, Gregg C.

AU - Panza, Julio A.

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N2 - BACKGROUND: The association of chronic renal insufficiency with outcomes after percutaneous coronary intervention (PCI) in the current era of drug-eluting stents and modern antithrombotic therapy has not been well characterized.METHODS AND RESULTS: We queried the 2007-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent PCI. Multivariable logistic regression was used to compare in-hospital outcomes among patients with chronic kidney disease (CKD), patients with end-stage renal disease (ESRD), and those without CKD or ESRD. Of 3 187 404 patients who underwent PCI, 89% had no CKD/ESRD; 8.6% had CKD; and 2.4% had ESRD. Compared to patients with no CKD/ESRD, patients with CKD and patients with ESRD had higher in-hospital mortality (1.4% versus 2.7% versus 4.4%, respectively; adjusted odds ratio for CKD 1.15, 95% CI 1.12 to 1.19, P<0.001; adjusted odds ratio for ESRD 2.29, 95% CI 2.19 to 2.40, P<0.001), higher incidence of postprocedure hemorrhage (3.5% versus 5.4% versus 6.0%, respectively; adjusted odds ratio for CKD 1.21, 95% CI 1.18 to 1.23, P<0.001; adjusted odds ratio for ESRD 1.27, 95% CI 1.23 to 1.32, P<0.001), longer average length of stay (2.9 days versus 5.0 days versus 6.4 days, respectively; P<0.001), and higher average total hospital charges ($60 526 versus $77 324 versus $97 102, respectively; P<0.001). Similar results were seen in subgroups of patients undergoing PCI for acute coronary syndrome or stable ischemic heart disease.CONCLUSIONS: In patients undergoing PCI, chronic renal insufficiency is associated with higher in-hospital mortality, higher postprocedure hemorrhage, longer average length of stay, and higher average hospital charges.

AB - BACKGROUND: The association of chronic renal insufficiency with outcomes after percutaneous coronary intervention (PCI) in the current era of drug-eluting stents and modern antithrombotic therapy has not been well characterized.METHODS AND RESULTS: We queried the 2007-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent PCI. Multivariable logistic regression was used to compare in-hospital outcomes among patients with chronic kidney disease (CKD), patients with end-stage renal disease (ESRD), and those without CKD or ESRD. Of 3 187 404 patients who underwent PCI, 89% had no CKD/ESRD; 8.6% had CKD; and 2.4% had ESRD. Compared to patients with no CKD/ESRD, patients with CKD and patients with ESRD had higher in-hospital mortality (1.4% versus 2.7% versus 4.4%, respectively; adjusted odds ratio for CKD 1.15, 95% CI 1.12 to 1.19, P<0.001; adjusted odds ratio for ESRD 2.29, 95% CI 2.19 to 2.40, P<0.001), higher incidence of postprocedure hemorrhage (3.5% versus 5.4% versus 6.0%, respectively; adjusted odds ratio for CKD 1.21, 95% CI 1.18 to 1.23, P<0.001; adjusted odds ratio for ESRD 1.27, 95% CI 1.23 to 1.32, P<0.001), longer average length of stay (2.9 days versus 5.0 days versus 6.4 days, respectively; P<0.001), and higher average total hospital charges ($60 526 versus $77 324 versus $97 102, respectively; P<0.001). Similar results were seen in subgroups of patients undergoing PCI for acute coronary syndrome or stable ischemic heart disease.CONCLUSIONS: In patients undergoing PCI, chronic renal insufficiency is associated with higher in-hospital mortality, higher postprocedure hemorrhage, longer average length of stay, and higher average hospital charges.

KW - chronic kidney disease

KW - end‐stage renal disease

KW - in‐hospital mortality

KW - percutaneous coronary intervention

KW - postprocedure hemorrhage

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