Abstract 4336: Acute Kidney Injury in Octogenarian Patients Undergoing Percutaneous Coronary Intervention: Predictors and Impact on Long Term Outcomes
OBJECTIVES: Because chronic renal failure (CRF) is often under-diagnosed in elderly patients, octogenarian patients may be at an especially high risk of acute kidney injury (AKI) following percutaneous coronary intervention (PCI). We sought to evaluate predictors and impact of AKI on clinical outcomes in octogenarians undergoing PCI.
METHODS: Retrospective cohort of consecutive octogenarians who underwent PCI at a tertiary care centre between 1/2002 and 12/2007. In-hospital events and clinical follow-up were collected by chart review and by phone interview. Patients were divided in two groups based on the development of AKI following PCI. AKI was defined using AKIN criteria. Predictors of post-PCI AKI were assessed with logistic regression. We compared in-hospital events and long-term survival between the two groups using chi-square test and the log-rank test, respectively.
RESULTS: During the study period, 988 octogenarians underwent PCI. Post-procedural creatinine was available in 422 patients. Long-term clinical follow-up was completed in all these patients. A total of 76 (18%) patients developed AKI. Patients who developed AKI were more likely to suffer from congestive heart failure (38% vs 21%, p=0.002), to present with ACS (90% vs 87%, p=0.039), and in cardiogenic shock (8% vs 3%, p=0.048), to suffer from 3-vessel coronary artery disease (41% vs 21%, p=0.0003) and they also had lower ejection fraction (42% vs 51%, p<0.0001). Independent predictors of AKI were lower ejection fraction (OR 1.4, IC 1.18 –1.74, p=0.0002), baseline creatinine (OR 1.01, IC 1–1.016, p=0.003) and 3-vessel disease (OR 1.74, CI 0.9 –3.1, p=0.06). Patients who developed AKI had higher in-hospital mortality (9% vs 2%, p=0.0026). One-year survival for patients who developed AKI was 73% compared to 87% for patients without this complication (p<0.0001). Difference in survival was sustained at a mean follow up of 912±584 days (p<0.0001).
CONCLUSIONS: AKI is particularly frequent in octogenarians undergoing PCI and has a deleterious impact on long-term survival. Efforts should be made to prevent this complication, especially in patients with low ejection fraction, 3-vessel disease and increased baseline creatinine.