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Impact of moderate or severe renal insufficiency on long-term outcomes in patients undergoing drug-eluting stent based coronary intervention

  • Rui Yan Zhang
    Affiliations
    Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China
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  • Zheng Bin Zhu
    Affiliations
    Institute of Cardiovascular Disease, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China
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  • Qi Zhang
    Affiliations
    Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China
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  • Zhen Kun Yang
    Affiliations
    Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China
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  • Jian Hu
    Affiliations
    Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China
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  • An Kang Lv
    Affiliations
    Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China
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  • Jian Sheng Zhang
    Affiliations
    Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China
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  • Wei Feng Shen
    Correspondence
    Corresponding author. Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai 200025, People’s Republic of China. Tel.: +86 21 64370045; fax: +86 21 6433 3548.
    Affiliations
    Department of Cardiology, Rui Jin Hospital, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China

    Institute of Cardiovascular Disease, Jiao Tong University School of Medicine, Shanghai 200025, People's Republic of China
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      Abstract

      Aims

      We sought to examine the impact of moderate or severe renal insufficiency (RI) on long-term clinical outcomes after successful percutaneous coronary intervention (PCI) with drug-eluting stent implantation.

      Methods

      All-cause mortality and major adverse cardiac events were prospectively determined for 1174 patients after successful PCI with drug-eluting stent implantation. Based on estimated creatinine clearance (CrCl) levels, long-term outcomes were compared between patients with CrCl<60 ml/min (RI group; n=460) and those with CrCl60 ml/min (control group; n=714). Hazard ratio for mortality and myocardial infarction was further evaluated for patients with severe (CrCl<30 ml/min), moderate (CrCl 30–59 ml/min), mild RI (CrCl 60–89 ml/min) and normal renal function (CrCl90 ml/min).

      Results

      Patients in RI group were older, lower body weight and hemoglobin, more female gender, and less cigarette smokers than those in control group. During follow-up (averaged 19.2 months) after successful PCI, all-cause death (8.3% vs. 1.5%, P<0.001), cardiac death (5.7% vs. 1.1%, P<0.001) and occurrence of non-fatal myocardial infarction (2.2% vs. 0.4%, P=0.005) were significantly higher, but rate of target vessel revascularization (TVR) was lower (5.7% vs. 9.6%, P=0.017) in RI group than in control group. Multivariate analysis revealed that CrCl<60 ml/min, diabetes, left ventricular ejection fraction <0.50 and anemia were independent risk factors for mortality and non-fatal myocardial infarction. Compared with patients with normal renal function, hazard ratio for a composite of mortality and myocardial infarction was 1.079 (P=0.907), 5.067 (P=0.007) and 8.828 (P=0.002) in patents with mild, moderate and severe RI, respectively.

      Conclusions

      Irrespective of whether drug-eluting stent implantation reduces TVR, the presence of moderate or severe RI is still associated with unfavorable long-term outcomes.

      Keywords

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