Impact of race and chronic kidney disease on 1-year outcome in patients undergoing percutaneous coronary interventions: a single tertiary center experience

Am Heart J. 2008 Jun;155(6):1027-32. doi: 10.1016/j.ahj.2008.01.004. Epub 2008 Mar 5.

Abstract

Background: Chronic kidney disease (CKD) is a predictor of morbidity and mortality in patients undergoing percutaneous coronary interventions (PCIs), and African American (AA) patients have been reported to have worse outcomes after PCI.

Methods: We assessed whether CKD affects the rate of death and major adverse cardiovascular events (MACE = myocardial infarction, revascularization, and death) differently in AA and white (CC) patients 1 year after PCI. Accordingly, we reviewed the database of all patients referred for PCI in the Emory Healthcare System between January 2001 and December 2004.

Results: We identified 800 CC and 116 AA patients with CKD among 4,372 patients referred for PCI. Chronic kidney disease was defined as an estimated glomerular filtration rate (eGFR) <60 mL/(min 1.73 m(2)) calculated by means of the Cockcroft-Gault equation. The AA patients with CKD were younger and had a larger number of comorbidities than the CC subjects. However, neither mortality nor MACE differed between races (14.7% vs 13.1%, P = .65 and 31.9% vs 31.3%, P = .89, respectively). In multivariable models, eGFR and emergency PCI were the best predictors of any adverse event, whereas prior PCI or coronary artery bypass surgery was a predictor of MACE alone. A test for interaction failed to show a significant effect of race and CKD on outcome.

Conclusions: In a tertiary referral center, AA and CC patients with CKD had a similar mortality rate and MACE at 1 year after PCI. Race was not a determinant of outcome, whereas CKD was.

MeSH terms

  • African Americans
  • Aged
  • Angioplasty, Balloon, Coronary*
  • European Continental Ancestry Group
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / ethnology*
  • Male
  • Middle Aged
  • Time Factors
  • Treatment Outcome