Abstract 5490: Contemporary Risk of In-Hospital Events in Dialysis Patients Undergoing Percutaneous Coronary Interventions: Insights From the NCDR Cath-PCI Registry
Background: While chronic renal insufficiency is associated with poor outcomes in patients undergoing percutaneous coronary intervention (PCI), little is known about the in-hospital outcomes of chronic dialysis patients due to very small numbers of patients.
Methods: 1,361,183 consecutive patients underwent PCI at 896 sites participating in the Cath-PCI registry from January 2004-September 2008. Patients were stratified by creatinine clearance (CrCl) into 4 groups: Normal renal function (CrCl ≥60 ml/min); Mild to moderate renal insufficiency (31≤CrCl<60 ml/min); severe renal insufficiency (CrCl≤30 ml/min) and dialysis dependent. Using multivariable regression analysis with generalized estimating equations, the associations between renal insufficiency and in-hospital bleeding, vascular complications and death were explored.
Results: Overall, 24,711 (1.8%) patients were dialysis dependent. In-hospital bleeding increased with worsening renal function (1.5% vs 2.8% vs 5.5% vs 3.7%, p<0.001) as did vascular complications (0.6% vs 0.9% vs 1.4% vs 1.3%, p<0.001) and in-hospital death (0.5% vs 1.6% vs 5.3% vs 4.7%, p<0.001). After multivariable adjustment, patients with worsening levels of renal insufficiency had progressively higher odds of in-hospital bleeding, vascular complications and death (Table⇓). Patients on dialysis represented the highest risk group overall.
Conclusion: Approximately 2% of PCI patients are on chronic dialysis and have high rates of in-hospital adverse events. Compared to patients with normal renal function, dialysis is strongly associated with increased bleeding, vascular complications and death. Strategies to improve the care and outcomes of dialysis patients receiving PCI are warranted.