Impact of Renal Dysfunction on Periprocedural Outcomes in Patients with Ischemic Cardiomyopathy Undergoing Elective Percutaneous Coronary Intervention (PCI)

Abstract

Background Ischemic cardiomyopathy is associated with multiple comorbidities including diabetes, hypertension, hyperlipidemia, and kidney disease. Patients with end-stage renal disease (ESRD) and left ventricular systolic heart failure have a 2-year cumulative survival as low as 33%. Chronic kidney disease (CKD) increases the risk of contrast-induced nephropathy and progression to ESRD in patients undergoing PCI. Hypothesis Patients with preoperative CKD undergoing elective revascularization with PCI for ischemic cardiomyopathy will have worse periprocedural outcomes. Methods Hospitalizations for systolic heart failure and PCI (and no acute myocardial infarction (MI)) were identified from the 2006-2014 National Inpatient Sample based on ICD-9 codes. Patients were categorized into normal renal function, preoperative CKD stages 1-4, or preoperative ESRD, and compared in terms of demographics, comorbidities, inpatient mortality, length of stay (LOS), and cost of care. Trends over time were determined using the Cochran Armitage and Cuzick tests. Multivariate models were constructed with logistic and linear regression (gamma function) using the NIS discharge weights and adjusted for age and comorbidities including hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking, and family history of MI. Results Patients with ESRD were at increased odds of dying during the perioperative period compared to normal renal function (OR = 2.54; 95%-c.i.=2.17-2.98). In-hospital mortality was 1.1% in normal renal function vs. 2.84% in patients with ESRD. LOS increased over time for the normal function group (mean 5.1 days) (p 0.05). LOS was on average 1.1 days longer (0.9-1.3) in the CKD stage 1-4 and 2.6 days longer (2.3-3.0) in the ESRD group compared to normal renal function. Although total charges increased over the study period in the normal renal function and ESRD groups (p Conclusions Patients with ESRD and CKD stages 1-4 undergoing PCI for ischemic cardiomyopathy have greater in-hospital mortality, LOS, and total charges and carry a higher rate of post-procedural complications.