Abstract 12683: Trends, Determinants and Implications of Nephropathy associated with Primary PCI: Insights from the BMC2 Registry
Background: Small studies suggest that nephropathy associated with primary percutaneous coronary intervention (NAPP) is associated with prolonged hospitalization, long-term renal impairment, and increased morbidity and mortality. This condition has not been studied in a large contemporary cohort of patients.
Methods: We analyzed tends, implications and predictors of NAPP in 10,839 patients who underwent primary PCI across 30 institutions between 2002 and 2009 and were enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) PCI registry. Patients were included if symptom onet was less than 12 hours to PCI, and excluded with a history of renal failure or dialysis. NAPP was defined as a rise in creatinine of 0.5 mg/dl or greater above baseline.
Results: NAPP developed in 781 (7.2%) of patients. Patients developing NAPP had a dramatically higher mortality (29.1 vs. 2.0%). The incidence of NAPP (figure 1 broken line) remained unchanged over time. The mortality among patients developing NAPP (figure 1 solid line) displayed an upward trend. Major factors associated with the development of NAPP were age greater than or equal to 80 (17.1 vs. 6.1%) baseline renal insufficiency with creatinine clearance < 30 (28.2 vs. 6.0%), presence of diabetes (12.6 vs. 5.6%), history of CHF (22.0 vs. 6.0%), history of peripheral vascular disease or stroke (13.6 vs. 6.1%), history of GIB (18.0 vs. 7.0%), history of atrial fibrillation (19.0 vs. 6.3%), contrast exceeding estimated maximum allowable dose (17.5 vs. 6.4%), and presentation in cardiogenic shock (24.6 vs. 5.0%).
Conclusions: Nephropathy associated with primary PCI imparts a dramatically elevated mortality hazard in patients with STEMI. Further research is warranted to assess if modification of contrast dose or other measures can reduce the occurrence of NAPP.
- © 2010 by American Heart Association, Inc.