Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation

L. A. Szczech, Patricia Best, E. Crowley, M. M. Brooks, P. B. Berger, V. Bittner, B. J. Gersh, R. Jones, R. M. Califf, H. H. Ting, P. J. Whitlow, K. M. Detre, David Holmes

Research output: Contribution to journalArticle

198 Citations (Scopus)

Abstract

Background - Although severe chronic kidney disease (CKD) is an independent predictor of mortality among patients with coronary artery disease, the impact of mild CKD on morbidity and mortality has not been fully defined. Methods and Results - Morbidity and mortality for the 3608 patients with multivessel coronary artery disease enrolled in the Bypass Angioplasty Revascularization Investigation randomized trial and registry were compared on the basis of the presence and absence of CKD, defined as a preprocedure serum creatinine level of >1.5 mg/dL. Seventy-six patients had CKD. Patients with renal insufficiency were older and more likely to have a history of diabetes, hypertension, and other comorbidities. Among patients undergoing PTCA, patients with CKD had a greater frequency of in-hospital death and cardiogenic shock (P<0.05 and 0.01, respectively). There was a trend toward a larger proportion of patients with CKD experiencing angina at 5 years (P=0.079). Patients with CKD had more cardiac admissions (P=0.003 and <0.0001 for patients undergoing PTCA and CABG, respectively) and a shorter time to subsequent CABG after initial revascularization than patients without CKD (P=0.01). CKD was associated with a higher risk of death at 7 years, both of all causes (relative risk 2.2, P<0.001) and of cardiac causes (relative risk 2.8, P<0.001). Conclusions - CKD is associated with an increased risk of recurrent hospitalization, subsequent CABG, and mortality. This increased risk of death is independent of and additive to the risk associated with diabetes.

Original languageEnglish (US)
Pages (from-to)2253-2258
Number of pages6
JournalCirculation
Volume105
Issue number19
DOIs
StatePublished - May 14 2002
Externally publishedYes

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Chronic Renal Insufficiency
Angioplasty
Mortality
Coronary Artery Disease
Morbidity
Cardiogenic Shock
Renal Insufficiency
Registries
Comorbidity
Creatinine
Hospitalization
Hypertension
Serum

Keywords

  • Coronary disease
  • Kidney
  • Mortality

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation. / Szczech, L. A.; Best, Patricia; Crowley, E.; Brooks, M. M.; Berger, P. B.; Bittner, V.; Gersh, B. J.; Jones, R.; Califf, R. M.; Ting, H. H.; Whitlow, P. J.; Detre, K. M.; Holmes, David.

In: Circulation, Vol. 105, No. 19, 14.05.2002, p. 2253-2258.

Research output: Contribution to journalArticle

Szczech, LA, Best, P, Crowley, E, Brooks, MM, Berger, PB, Bittner, V, Gersh, BJ, Jones, R, Califf, RM, Ting, HH, Whitlow, PJ, Detre, KM & Holmes, D 2002, 'Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation', Circulation, vol. 105, no. 19, pp. 2253-2258. https://doi.org/10.1161/01.CIR.0000016051.33225.33
Szczech, L. A. ; Best, Patricia ; Crowley, E. ; Brooks, M. M. ; Berger, P. B. ; Bittner, V. ; Gersh, B. J. ; Jones, R. ; Califf, R. M. ; Ting, H. H. ; Whitlow, P. J. ; Detre, K. M. ; Holmes, David. / Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation. In: Circulation. 2002 ; Vol. 105, No. 19. pp. 2253-2258.
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AU - Szczech, L. A.

AU - Best, Patricia

AU - Crowley, E.

AU - Brooks, M. M.

AU - Berger, P. B.

AU - Bittner, V.

AU - Gersh, B. J.

AU - Jones, R.

AU - Califf, R. M.

AU - Ting, H. H.

AU - Whitlow, P. J.

AU - Detre, K. M.

AU - Holmes, David

PY - 2002/5/14

Y1 - 2002/5/14

N2 - Background - Although severe chronic kidney disease (CKD) is an independent predictor of mortality among patients with coronary artery disease, the impact of mild CKD on morbidity and mortality has not been fully defined. Methods and Results - Morbidity and mortality for the 3608 patients with multivessel coronary artery disease enrolled in the Bypass Angioplasty Revascularization Investigation randomized trial and registry were compared on the basis of the presence and absence of CKD, defined as a preprocedure serum creatinine level of >1.5 mg/dL. Seventy-six patients had CKD. Patients with renal insufficiency were older and more likely to have a history of diabetes, hypertension, and other comorbidities. Among patients undergoing PTCA, patients with CKD had a greater frequency of in-hospital death and cardiogenic shock (P<0.05 and 0.01, respectively). There was a trend toward a larger proportion of patients with CKD experiencing angina at 5 years (P=0.079). Patients with CKD had more cardiac admissions (P=0.003 and <0.0001 for patients undergoing PTCA and CABG, respectively) and a shorter time to subsequent CABG after initial revascularization than patients without CKD (P=0.01). CKD was associated with a higher risk of death at 7 years, both of all causes (relative risk 2.2, P<0.001) and of cardiac causes (relative risk 2.8, P<0.001). Conclusions - CKD is associated with an increased risk of recurrent hospitalization, subsequent CABG, and mortality. This increased risk of death is independent of and additive to the risk associated with diabetes.

AB - Background - Although severe chronic kidney disease (CKD) is an independent predictor of mortality among patients with coronary artery disease, the impact of mild CKD on morbidity and mortality has not been fully defined. Methods and Results - Morbidity and mortality for the 3608 patients with multivessel coronary artery disease enrolled in the Bypass Angioplasty Revascularization Investigation randomized trial and registry were compared on the basis of the presence and absence of CKD, defined as a preprocedure serum creatinine level of >1.5 mg/dL. Seventy-six patients had CKD. Patients with renal insufficiency were older and more likely to have a history of diabetes, hypertension, and other comorbidities. Among patients undergoing PTCA, patients with CKD had a greater frequency of in-hospital death and cardiogenic shock (P<0.05 and 0.01, respectively). There was a trend toward a larger proportion of patients with CKD experiencing angina at 5 years (P=0.079). Patients with CKD had more cardiac admissions (P=0.003 and <0.0001 for patients undergoing PTCA and CABG, respectively) and a shorter time to subsequent CABG after initial revascularization than patients without CKD (P=0.01). CKD was associated with a higher risk of death at 7 years, both of all causes (relative risk 2.2, P<0.001) and of cardiac causes (relative risk 2.8, P<0.001). Conclusions - CKD is associated with an increased risk of recurrent hospitalization, subsequent CABG, and mortality. This increased risk of death is independent of and additive to the risk associated with diabetes.

KW - Coronary disease

KW - Kidney

KW - Mortality

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