title: Impact of renal failure on all-cause mortality and other outcomes in patients treated by percutaneous coronary intervention.
abstract: BACKGROUND
  Patients with renal failure (RF) have been systematically excluded from clinical trials; consequently their outcomes have not been well studied in the setting of percutaneous coronary intervention (PCI).
  
  
  OBJECTIVE
  To compare cardiovascular outcomes after contemporary PCI in patients with versus without RF, according to clinical presentation (ST-segment elevation myocardial infarction [STEMI], acute coronary syndrome [ACS] or stable coronary artery disease [sCAD]).
  
  
  METHODS
  Consecutive patients undergoing PCI with stent were prospectively included from 2007 to 2012. RF was defined as creatinine clearance<60mL/min. The primary endpoint was all-cause mortality; secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE: composite of cardiovascular death, myocardial infarction, stroke and target lesion revascularization [TLR]), TLR and Academic Research Consortium definite/probable stent thrombosis (ST) at 1 year.
  
  
  RESULTS
  Among 5337 patients, 23% had PCI for STEMI, 34% for ACS and 43% for sCAD, while 27% had RF. RF patients had a higher unadjusted death rate than those with preserved renal function (nRF) in all PCI indication groups (STEMI, 41% vs. 7.5%; ACS, 19% vs. 6%; sCAD, 10% vs. 3%; P<0.0001 for all). The rate of MACCE was also higher in RF patients whatever the PCI indication (STEMI, 45% vs. 15%; ACS, 23% vs. 14%; sCAD, 14% vs. 9%; P<0.05 for all). Rates of TLR (5.5-7.4%) and ST (<2.5%) were similar (P>0.05 for both). sCAD-RF and STEMI-nRF patients had similar rates of mortality (P=0.209) and MACCE (P=0.658). RF was independently associated with mortality, with a doubled relative risk in STEMI versus ACS and sCAD groups (odds ratio 5.3, 95% confidence interval 3.627-7.821 vs. 2.1, 1.465-3.140 and 2.3, 1.507-3.469, respectively; P<0.0001).
  
  
  CONCLUSIONS
  RF is a stronger independent predictor of death after PCI in STEMI than in ACS or sCAD patients. sCAD-RF and STEMI-nRF patients had similar prognoses.
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France; Cardiology Department, Clinical Hospital Zvezdara, Belgrade, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Loncar
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France. Electronic address: olivier.barthelemy@psl.aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthelemy
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Berman
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kerneis
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Petroni
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Payot
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Remi
authors.initials: R
authors.lastname: Choussat
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Helft
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.affiliation: Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Le Feuvre
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D000368:Aged; D002423:Cause of Death; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D011446:Prospective Studies; D012042:Registries; D051437:Renal Insufficiency / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Angioplastie coronaire; Insuffisance rénale; PCI; Renal failure; STEMI