Acute renal failure requiring dialysis after percutaneous coronary interventions

Abstract

Acute renal failure requiring dialysis is a rare but serious complication after percutaneous coronary interventions (PCI), associated with high in‐hospital mortality and poor long‐term survival. We have analyzed the incidence, resource utilization, short‐ and long‐term outcomes, and predictors of dialysis after percutaneous coronary interventions. We studied 51 consecutive patients who were not on dialysis on admission and developed acute renal failure that required in‐hospital dialysis after PCI in comparison to the 7,690 patients who did not require dialysis after PCI. Patients who required dialysis were older, with a higher incidence of hypertension, diabetes, prior bypass surgery, chronic renal failure, and a significantly lower left ventricular ejection fraction. Despite similar angiographic success, these patients had a higher incidence of in‐hospital mortality (27.5% vs. 1.0%, P < 0.0001), non–Q‐wave myocardial infarction (45.7% vs. 14.6%, P < 0.0001), vascular and bleeding complications, and longer hospitalization. At 1‐year follow‐up, mortality (54.5% vs. 6.4%, P < 0.0001), myocardial infarction (4.5% vs. 1.6%, P = 0.006), and event‐free survival (38.6% vs. 72.0%, P < 0.0001) were significantly worse in patients who required dialysis compared to patients who did not. Multivariate analysis revealed in‐hospital dialysis and an increase in baseline serum creatinine levels as the most important predictors of in‐hospital and long‐term mortality. Thus, acute renal failure that requires dialysis after percutaneous coronary interventions is associated with very high in‐hospital and 1‐year mortality rates and a dramatic increase in hospital resource utilization. Cathet Cardiovasc Intervent 2001;52:409–416.