AIMS: To establish the relationship between renal insufficiency, bleeding and prescription of cardiovascular medication. METHODS AND RESULTS: This was a prospective, multi-center, cohort study of consecutive patients undergoing PCI during three NHLBI Dynamic Registry recruitment waves. Major and minor bleeding, access site bleeding and rates of prescription of cardiovascular medication at discharge were determined based on estimated glomerular filtration rate (eGFR). Renal insufficiency was an independent predictor of major adverse cardiovascular events (MACE). Bleeding events and access site bleeding requiring transfusion were significantly associated with degrees of renal insufficiency (p<0.001). There was an incremental decline in prescription of cardiovascular medication at discharge proportionate to the degree of renal impairment (aspirin, thienopyridine, statin, coumadin (overall p<0.001), beta blocker (overall p=0.003), ACE inhibitor (overall p=0.02). Bleeders were less likely to be discharged on a thienopyridine (95.4% versus 89.9% for bleeding, p<0.001 and 95.3% versus 87.9% for access site bleeding, p=0.005), but not aspirin (96.3% versus 96.2%, p=0.97 and 96.3% versus 93.6%, p=0.29 respectively). Failure to prescribe anti-platelet therapy at discharge was strongly associated with increased MACE at one year. CONCLUSIONS: Renal insufficiency is associated with bleeding in patients undergoing PCI. Patients with renal insufficiency are less likely to receive recommended discharge pharmacotherapy.
- Klíčová slova
- Antiplatelet, Cardiovascular medication, Percutaneous coronary intervention, Renal insufficiency,
- MeSH
- časové faktory MeSH
- dialýza ledvin MeSH
- hodnocení rizik MeSH
- hodnoty glomerulární filtrace MeSH
- infarkt myokardu komplikace diagnóza mortalita terapie MeSH
- inhibitory agregace trombocytů terapeutické užití MeSH
- kardiovaskulární látky škodlivé účinky terapeutické užití MeSH
- koronární angioplastika škodlivé účinky mortalita MeSH
- krevní transfuze MeSH
- krvácení chemicky indukované etiologie mortalita terapie MeSH
- ledviny patofyziologie MeSH
- lékové předpisy MeSH
- lidé středního věku MeSH
- lidé MeSH
- National Heart, Lung, and Blood Institute (U.S.) * MeSH
- propuštění pacienta * MeSH
- prospektivní studie MeSH
- recidiva MeSH
- registrace MeSH
- renální insuficience komplikace mortalita patofyziologie terapie MeSH
- rizikové faktory MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
- Kanada MeSH
- Spojené státy americké MeSH
- Názvy látek
- inhibitory agregace trombocytů MeSH
- kardiovaskulární látky MeSH
