Abstract 1689: Transient and Persistent Postprocedural Renal Dysfunction as Predictors of 8 Year Mortality after Cardiac Catheterization Insights from the Dartmouth Dynamic Registry
Introduction: Limited data exist that define the natural history of contrast induced nephropathy (CIN) over very long term follow-up. The purpose of this investigation was to determine the relationship of transient post catheterization renal dysfunction on long term mortality and define the natural survival history of patients with temporary and persistent post procedural renal failure.
Methods: Data were prospectively collected for 13,110 consecutive patients with baseline, peak < 48 hour, and 2 week creatinine data undergoing catheterization from 1998–2006. CIN was defined as (≥25% increase in creatinine within 48 hours of procedure. Patients were stratified into three categories: no creatinine elevation from baseline (no CIN), transient creatinine elevation (CIN with returning to normal within 2 weeks), and persistent creatinine elevation (CIN without returning to normal within 2 weeks). Mortality was determined by a match to the Social Security Death Master File.
Results: 11,657 patients (88.9%) had <25% rise in creatinine within 48 hours of the procedure; 1,453 (11.1%) patients developed CIN with ≥25% increase in creatinine within 48 hours: 593 (4.5%) transient and 860 (6.6%) persistent creatinine elevations. The eight-year incidence of death (per 10 person-years of follow-up) for patients were: 3.9 without CIN, 10.0 for transient CIN, and 9.2 for persistent CIN. Patients with transient or persistent CIN had a 2-fold increased adjusted risk of 8-year mortality compared with patients without CIN.
Conclusions: Both transient and persistent post procedural renal dysfunction are prognostically significant for mortality during very extended follow-up.