Baylor University Medical Center Proceedings October 2017 - 402

100

All ptrend < 0.05

Percentages (%)

90
80
70
60
50
40
30
20
10
0

2006 2007 2008 2009 2010 2011 2012
NO CKD

2006 2007 2008 2009 2010 2011 2012
CKD III-V

2006 2007 2008 2009 2010 2011 2012
E SR D

%Catheterization

56.8 57.6 58.5 62.5 62.8 64.1 67.4

44.6 42.4 40.5 43.9 44.1 43.7 45.7

47.9 48.6 47.5 51.8 52.2 54.2 56.4

% PCI

29.9 29.4 30.9 33.4 32.7 34.8 36.8

18.2 17.1 17.9 19.6 19.6 20.4 21.5

19.8 19.7 21.0 23.7 23.5 26.0 27.5

%In-hospital mortality

3.6

6.1

9.6

3.3

3.5

3.0

2.9

2.9

2.9

5.7

5.9

5.5

5.4

4.9

5.3

100

9.1

8.5

8.4

7.7

7.3

7.1

All ptrend < 0.05

90

Percentages (%)

80
70
60
50
40
30
20
10
0

2006 2007 2008 2009 2010 2011 2012

2006 2007 2008 2009 2010 2011 2012

NO CKD

C KD I II - V

2006 2007 2008 2009 2010 2011 2012
ESRD

%Catheterization

73.0 75.7 78.7 82.0 83.9 85.0 87.3

56.5 52.3 53.8 60.6 61.5 61.4 67.6

51.0 51.7 54.5 57.2 61.3 61.0 65.7

% PCI

57.0 60.4 64.9 68.9 71.4 73.5 76.0

33.0 34.2 38.8 43.6 44.6 45.1 52.6

29.9 30.3 36.8 38.8 40.5 40.1 42.9

%In-hospital mortality

8.1

13.7 12.4 13.4 12.6 12.5 13.2 13.9

23.5 26.4 23.8 25.4 24.4 24.3 25.6

8.3

8.2

7.7

7.4

7.5

7.2

Figure 1. Cardiac catheterization, percutaneous interventions, and inpatient mortality from 2006 to 2012 in (a) patients presenting with unstable angina/non-ST
elevation myocardial infarction according to baseline renal function and (b) patients presenting with ST-elevation myocardial infarction according to baseline renal
function. CKD indicates chronic kidney disease; ESRD, end-stage renal disease; STEMI, ST elevation myocardial infarction.

1 year of analysis (3). PCI is associated with higher contrast
exposure, increasing the risk for CIN and long-term renal
impairment. Strategies such as volume expansion reduce the
incidence of CIN, allowing clinicians to expand use of PCI
among higher-risk populations (4). Another strategy involves
a more selective approach to left ventriculography, thus limiting contrast use with renal dysfunction. Overall reductions in
the absolute contrast volume and use of low- to iso-osmolar
contrast agents have been associated with a lower risk of CIN
(5). Patient choice plays a significant role in the decisionmaking process when presented with the higher risk for dialysis
among those with increasing severity of CKD. Improvements
in practice and evolution in physician and patient attitudes
may have contributed to the overall uptrend in performance
of CAG and PCI.
402

Our study has several limitations inherent to its retrospective
design, use of an administrative database, and dependence on
ICD-9CM coding. We were unable to determine the temporal
relationship between acute kidney injury and PCI/CAG which
would influence decision making. The overall PCI rate was
relatively low, maybe due to revascularization at a separate visit.
We chose to exclude patients with an undetermined stage of
CKD and did not examine trends in alternative revascularization
strategies. We relied on diagnosis codes to stratify the groups,
and the database does not provide information on CIN.
In summary, there has been an increase in the use of PCI
between 2006 and 2012 among patients with AMI, irrespective
of the presence of baseline CKD. Patients with advanced CKD
and AMI were less likely to undergo CAG or subsequent PCI
and experienced a higher rate of in-hospital mortality compared

Baylor University Medical Center Proceedings

Volume 30, Number 4



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