A novel clinical prediction rule can determine which patients are at high risk for serious renal dysfunction following percutaneous coronary interventions, an infrequent occurrence but one associated with a very high inpatient mortality, according to findings published in the February issue of the
American Heart Journal.While a prediction rule for post-PCI contrast-induced nephropathy has been developed, "little work has been done on predicting pre-PCI patient-specific risk for developing more serious renal dysfunction," Dr. Jeremiah R. Brown, of Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and colleagues write.
The team prospectively collected data on 11,141 consecutive patients undergoing PCI in northern New England from 2003 to 2005, and used multivariate logistic regression analyses to identify the combination of patient characteristics that was most predictive of developing post-PCI serious renal dysfunction.
Eighty-three patients (0.74 per cent) developed serious renal dysfunction, resulting in a mortality rate 19.3 per cent higher compared with patient without serious renal dysfunction. The model discriminated well between patients who did and those who did not develop post-PCI serious renal dysfunction.
Three factors accounted for 76 per cent of the predictive ability of the model. These included preprocedural creatinine (37 per cent), congestive heart failure (24 per cent) and diabetes (15 per cent). The remaining factors included urgent priority and emergency priority (ten per cent), preprocedural intra-aortic balloon pump use (eight per cent), age 80 years and older (five per cent), and female sex (one per cent).
"We can use this model to risk-stratify patients prior to the procedure, which will inform both the patient and clinician about the risk of kidney damage and death," Dr. Brown told Reuters Health.
"The pre-procedural risk score can then be used to customize preventive strategies for the patient before, during, and after the procedure," he noted.
This might include hydrating the patient with sodium bicarbonate and N-acetylcysteine, which may reduce kidney damage by more than 80 per cent, he said, or minimizing the amount of contrast dye used during the procedure.
