Impact of chronic kidney disease on the incidence of peri-procedural myocardial injury in patients undergoing elective stent implantation

S. Kumagai, H. Ishii, T. Amano, T. Uetani, B. Kato, K. Harada, T. Yoshida, H. Ando, A. Kunimura, Y. Shimbo, K. Kitagawa, K. Harada (+4 others)
2011 Nephrology, Dialysis and Transplantation  
Background. It is well known that chronic kidney disease is a strong independent predictor of adverse outcomes after percutaneous coronary intervention in patients with ischemic heart disease. Recently, peri-procedural myocardial injury has been associated with adverse cardiac events. The aim of this study was to investigate the relationship between renal function and peri-procedural myocardial injury in patients undergoing elective stent implantation. Methods. This study comprised 273
more » ... ve patients who underwent elective stent implantation. They were divided into two groups: estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m 2 and eGFR !60 mL/ min/1.73m 2 . Peri-procedural TnT levels higher than three times the normal limit were defined as peri-procedural myocardial injury. Results. Patients with eGFR <60 mL/min/1.73m 2 showed a higher incidence of peri-procedural myocardial injury compared to patients with eGFR !60 mL/min/1.73m 2 (4.3 versus 20.9%, P < 0.0001). Even after a multivariate adjustment, the eGFR level predicted peri-procedural myocardial injury [odds ratio 0.92, 95% confidence interval (CI): 0.89-0.95, P < 0.0001]. Total stent length was also an independent predictor of peri-procedural myocardial injury (odds ratio 1.09, 95% CI: 1.02-1.16, P ¼ 0.009). Using a receiver-operating curve analysis, eGFR level of 62.1 mL/ min/1.73m 2 (sensitivity 93.3%, specificity 57.2%) was the best value (area under the curve ¼ 0.803) to maximize the power of eGFR levels in predicting peri-procedural myocardial injury. Conclusions. Patients with eGFR <60 mL/min/1.73m 2 were strongly associated with peri-procedural myocardial injury after elective stent implantation. Therefore, eGFR may be a simple and convenient predictor of periprocedural myocardial injury.
doi:10.1093/ndt/gfr411 pmid:21771758 fatcat:3l7bha2mvfavbpo73pveednqm4