Coronary revascularization in patients with renal insufficiency: restenosis rate and cardiovascular outcomes.
Several interventional trials have shown a lower success rate for coronary angioplasty and lower long-term event-free survival in patients with renal insufficiency, and data are conflicting about restenosis after coronary angioplasty. This study included 4,131 consecutive patients with coronary artery disease treated with coronary angioplasty (23%) or stenting (77%). Renal insufficiency is defined as a creatinine clearance (CrCl) less than 60 mL/min (<1.0 mL/s). Of 4,131 patients, 1,412 patients (34.2%) had renal insufficiency and 2,719 patients (65.8%) did not have renal insufficiency. The primary end point of the study is clinical restenosis, defined as the need for target-lesion revascularization. There was no difference in clinical restenosis rates between groups after 1 year (18.8% versus 18.4%; P = 0.75). The incidence of angiographic restenosis at the 6-month angiography was 32.7% in the group with renal insufficiency and 29.7% in the group without renal insufficiency ( P = 0.10). The composite end point of death and myocardial infarction was observed more frequently in patients with than without renal insufficiency (8.3% versus 3.2%; P < 0.001). Renal insufficiency was not independently associated with clinical restenosis (for 10-mL/min [0.167-mL/s]) decrease in CrCl, adjusted odds ratio, 1.03; 95% confidence interval [CI], 0.98 to 1.08; P = 0.198), but remained as an independent predictor for death or myocardial infarction (for 10-mL/min [0.167-mL/s] decrease in CrCl, hazard ratio, 1.29; 95% CI, 1.18 to 1.42; P < 0.001). Patients with renal insufficiency do not show an increased incidence of restenosis after coronary revascularization.