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

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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 CrCl ≥ 60 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 (CrCl ≥ 90 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.