title: Preprocedural creatinine clearance and long term survivalafter successful coronary stenting.
abstract: OBJECTIVE
  The clinical outcome of patients with severe renal dysfunction undergoing percutaneous coronary intervention (PCI) is poor. However little is known concerning the impact of mild renal insufficiency on long-term clinical outcomes after successful coronary stenting. The present prospective observational study was designed to evaluate long-term clinical outcomes in relation to renal insufficiency after successful coronary stenting.
  
  
  RESULTS
  A consecutive series of 1454 patients were enrolled between January 4th 1997 and January 4th 1999 Demographic and clinical characteristics and long term clinical outcome were compared for patients with normal creatinine clearance (>60 ml/mn), mild renal dysfunction (creatinine clearance rates 30-60 ml/mn) and severe renal dysfunction (creatinine clearance rates <30 ml/mn). Patients with moderate or severe renal dysfunction were older and with more severe coronary artery disease. Beyond conventional risk factors like age (RR = 1.72 [1.10-2.68] 95% CI ; p<0.018), or low left ventricular ejection fraction (RR = 2.60 [1.72-3.94] 95% CI ; p<0.001), severe (creatinine clearance rates < 30 ml/min) and mild (creatinine clearance 30-60 ml/min) renal dysfunction were also identified as strong independent predictors of death after successful coronary stenting (RR = 4.91 [2.63-9.15] 95% CI, p<0.001 and RR = 1.57 [1.03-2.40] 95% CI, p<0.034, respectively).
  
  
  CONCLUSIONS
  In patients with successful coronary stenting, preprocedural creatinine clearance remains an important independent predictor of long term death. These data reinforce the importance of widespread application of prevention strategies especially in patients with coronary artery disease complicated by renal dysfunction.
authors.affiliation: Department of Cardiology, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen cedex, Normandy, France.
authors.forename: Karam
authors.initials: K
authors.lastname: Souibri
authors.forename: Remy
authors.initials: R
authors.lastname: Morello
authors.forename: Sabine
authors.initials: S
authors.lastname: Fradin
authors.forename: Gilles
authors.initials: G
authors.lastname: Grollier
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Ryckelynck
authors.forename: Martial
authors.initials: M
authors.lastname: Hamon