In a contemporary study, Laskey et al studied 3179 consecutive patients undergoing PCI and found that a contrast volume to creatinine clearance ratio 3.7 was a significant and inde- pendent predictor of an early and abnormal increase in serum creatinine.166 In an earlier trial, administration of a contrast volume of 5 mL body weight (kg)/serum creatinine (mg/ dL), applied to 16 592 patients undergoing cardiac catheter- ization, was associated with a 6-fold increase in the likelihood of patients developing CIN requiring dialysis.167 Patients with CKD are consistently underrepresented in randomized controlled trials of cardiovascular disease.192 The impact of an invasive strategy has been uncertain in this group. The SWEDEHEART (Swedish Web-System for En- hancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Ther- apies) study included a cohort of 23 262 patients hospitalized for NSTEMI in Sweden between 2003 and 2006 who were age 80 years.169 This contemporary nationwide registry of nearly all consecutive patients examined the distribution of CKD and the use of early revascularization after NSTEMI and evaluated whether early revascularization (by either PCI or CABG) within 14 days of admission for NSTEMI altered outcomes at all stages of kidney function. In SWEDEHEART, all-cause mortality was assessed at 1 year and was available in 99% of patients. Moderate or more advanced CKD (estimated glomerular filtration rate ) was present in 5689 patients (24.4%). After multivariable adjustment, the 1-year mortality in the overall cohort was 36% lower with early P 0.001).169 The magnitude of the difference in 1-year mortality was similar in patients with normal eGFR (early revascularization versus medically treated: 1.9% versus 10%; 95% CI: 0.52 to 0.80; P 0.001), and moderate CKD [eGFR 95% CI: 0.54 to 0.86; P 0.001). 