Combined Impact of Age and Estimated Glomerular Filtration Rate on In-Hospital Mortality After Percutaneous Coronary Intervention for Acute Myocardial Infarction (from the American College of Cardiology National Cardiovascular Data Registry)

Published:January 27, 2009DOI:
      Age and chronic kidney disease are major risk factors for poor cardiovascular outcome; however, renal function is often estimated on the basis of serum creatinine levels, and advanced renal impairment may be hidden behind near normal creatinine levels. We assessed the impact of estimated glomerular filtration rate (GFR) on in-hospital mortality in young (<65 years old), old (65 to 84 years old), and very old (≥85 years old) patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction. The adjusted risk of death was calculated in 169,826 patients from the American College of Cardiology National Cardiovascular Data Registry undergoing primary PCI for acute myocardial infarction. Younger patients had fewer co-morbidities, higher estimated GFR, less frequent multivessel disease, and lower unadjusted mortality rates than older patients (p <0.0001 for all comparisons). However, the adjusted risk of in-hospital mortality for patients with severe renal insufficiency (estimated GFR <30 ml/min/1.73 m2) compared with those with normal renal function (estimated GFR ≥60 ml/min/1.73 m2) was higher in young patients (adjusted odds ratio = 7.58, 95% confidence interval 6.18 to 9.29) than old (adjusted odds ratio = 4.75, 95% confidence interval 4.14 to 5.45) and very old patients (adjusted odds ratio = 3.50, confidence interval 2.50 to 4.89). In conclusion, severe renal insufficiency is associated with a greater risk of in-hospital mortality in young than old and very old patients after primary PCI. Risk stratification for patients with acute myocardial infarction should incorporate an assessment of renal function with estimated GFR values rather than absolute serum creatinine levels as done in the currently utilized risk scoring algorithms.
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        • Feldman D.N.
        • Gade C.L.
        • Slotwiner A.J.
        • Parikh M.
        • Bergman G.
        • Wong S.C.
        • Minutello R.M.
        Comparison of outcomes of percutaneous coronary interventions in patients of three age groups (<60, 60 to 80, and >80 years) (from the New York State Angioplasty Registry).
        Am J Cardiol. 2006; 98: 1334-1339
        • Gruberg L.
        • Dangas G.
        • Mehran R.
        • Mintz G.S.
        • Kent K.M.
        • Pichard A.D.
        • Satler L.F.
        • Lansky A.J.
        • Stone G.W.
        • Leon M.B.
        Clinical outcome following percutaneous coronary interventions in patients with chronic renal failure.
        Catheter Cardiovasc Interv. 2002; 55: 66-72
        • Klein L.W.
        • Block P.
        • Brindis R.G.
        • McKay C.R.
        • McCallister B.D.
        • Wolk M.
        • Weintraub W.
        Percutaneous coronary interventions in octogenarians in the American College of Cardiology-National Cardiovascular Data Registry: development of a nomogram predictive of in-hospital mortality.
        J Am Coll Cardiol. 2002; 40: 394-402
        • Naidu S.S.
        • Selzer F.
        • Jacobs A.
        • Faxon D.
        • Marks D.S.
        • Johnston J.
        • Detre K.
        • Wilensky R.L.
        Renal insufficiency is an independent predictor of mortality after percutaneous coronary intervention.
        Am J Cardiol. 2003; 92: 1160-1164
        • Singh M.
        • Rihal C.S.
        • Selzer F.
        • Kip K.E.
        • Detre K.
        • Holmes D.R.
        Validation of Mayo Clinic risk adjustment model for in-hospital complications after percutaneous coronary interventions, using the National Heart, Lung, and Blood Institute dynamic registry.
        J Am Coll Cardiol. 2003; 42: 1722-1728
        • Wu C.
        • Hannan E.L.
        • Walford G.
        • Ambrose J.A.
        • Holmes Jr, D.R.
        • King 3rd, S.B.
        • Clark L.T.
        • Katz S.
        • Sharma S.
        • Jones R.H.
        A risk score to predict in-hospital mortality for percutaneous coronary interventions.
        J Am Coll Cardiol. 2006; 47: 654-660
        • Yamaguchi J.
        • Kasanuki H.
        • Ishii Y.
        • Yagi M.
        • Ogawa H.
        • Fujii S.Y.
        • Koganei H.
        • Okada H.
        • Kimura H.
        • Horie T.
        • et al.
        Prognostic significance of serum creatinine concentration for in-hospital mortality in patients with acute myocardial infarction who underwent successful primary percutaneous coronary intervention (from the Heart Institute of Japan Acute Myocardial Infarction [HIJAMI] Registry).
        Am J Cardiol. 2004; 93: 1526-1528
        • Best P.J.
        • Lennon R.
        • Ting H.H.
        • Bell M.R.
        • Rihal C.S.
        • Holmes D.R.
        • Berger P.B.
        The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions.
        J Am Coll Cardiol. 2002; 39: 1113-1119
        • Blackman D.J.
        • Pinto R.
        • Ross J.R.
        • Seidelin P.H.
        • Ing D.
        • Jackevicius C.
        • Mackie K.
        • Chan C.
        • Dzavik V.
        Impact of renal insufficiency on outcome after contemporary percutaneous coronary intervention.
        Am Heart J. 2006; 151: 146-152
        • Hirakawa Y.
        • Masuda Y.
        • Kuzuya M.
        • Iguchi A.
        • Kimata T.
        • Uemura K.
        Association of renal insufficiency with in-hospital mortality in Japanese patients with acute myocardial infarction undergoing percutaneous coronary interventions.
        Int Heart J. 2006; 47: 745-752
        • National Kidney Foundation
        K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
        Am J Kidney Dis. 2002; 39: S1-S266
        • Assali A.R.
        • Moustapha A.
        • Sdringola S.
        • Salloum J.
        • Awadalla H.
        • Saikia S.
        • Ghani M.
        • Hale S.
        • Schroth G.
        • Rosales O.
        • Anderson H.V.
        • Smalling R.W.
        The dilemma of success: percutaneous coronary interventions in patients > or = 75 years of age-successful but associated with higher vascular complications and cardiac mortality.
        Catheter Cardiovasc Interv. 2003; 59: 195-199
        • Go A.S.
        • Chertow G.M.
        • Fan D.
        • McCulloch C.E.
        • Hsu C.Y.
        Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.
        N Engl J Med. 2004; 351: 1296-1305
        • Fried L.F.
        • Shlipak M.G.
        • Crump C.
        • Bleyer A.J.
        • Gottdiener J.S.
        • Kronmal R.A.
        • Kuller L.H.
        • Newman A.B.
        Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals.
        J Am Coll Cardiol. 2003; 41: 1364-1372
        • Sadeghi H.M.
        • Stone G.W.
        • Grines C.L.
        • Mehran R.
        • Dixon S.R.
        • Lansky A.J.
        • Fahy M.
        • Cox D.A.
        • Garcia E.
        • Tcheng J.E.
        • et al.
        Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction.
        Circulation. 2003; 108: 2769-2775
        • Shlipak M.G.
        • Fried L.F.
        • Crump C.
        • Bleyer A.J.
        • Manolio T.A.
        • Tracy R.P.
        • Furberg C.D.
        • Psaty B.M.
        Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency.
        Circulation. 2003; 107: 87-92
        • Van Den Noortgate N.J.
        • Janssens W.H.
        • Delanghe J.R.
        • Afschrift M.B.
        • Lameire N.H.
        Serum cystatin C concentration compared with other markers of glomerular filtration rate in the old old.
        J Am Geriatr Soc. 2002; 50: 1278-1282
        • Wasen E.
        • Isoaho R.
        • Mattila K.
        • Vahlberg T.
        • Kivela S.L.
        • Irjala K.
        Estimation of glomerular filtration rate in the elderly: a comparison of creatinine-based formulae with serum cystatin C.
        J Intern Med. 2004; 256: 70-78