title: Temporal Trends in Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Renal Insufficiency.
abstract: OBJECTIVE
  Renal insufficiency is associated with worse clinical outcomes in patients with coronary artery disease. Since the introduction of percutaneous coronary intervention (PCI), the revascularization therapy has evolved with advances of devices, improvements in operator techniques, and the establishment of medical therapy. We examined temporal trends of the clinical outcomes following PCI in patients with renal insufficiency.
  
  
  METHODS
  Patients with renal insufficiency after PCI at Juntendo University across three eras (plain balloon angioplasty, bare metal stent (BMS), and drug-eluting stent (DES)) were examined in this study. The primary endpoint was a composite of all-cause mortality, nonfatal acute coronary syndrome, nonfatal stroke, and repeat revascularization within 3-years after the index revascularization.
  
  
  RESULTS
  A total of 1,420 patients were examined. Baseline characteristics have become unfavorable over time, whereas administration rate of medications for secondary prevention has increased. The event-free survival rates for the endpoint were different among the groups. Adjusted relative risk reduction for the endpoint was 35% and 51% in the BMS and DES eras (using the plain angioplasty era as reference). The adjusted relative risk reduction of the DES era was 26% compared with that of the BMS era.
  
  
  CONCLUSIONS
  The incidence of cardiovascular events after PCI has reduced during the 26-year period mainly because of the reduction in repeat revascularization in patients with renal insufficiency, despite the higher risk profiles in the recent era.
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
authors.forename: Ryo
authors.initials: R
authors.lastname: Naito
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.forename: Jun
authors.initials: J
authors.lastname: Shitara
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Endo
authors.forename: Hideki
authors.initials: H
authors.lastname: Wada
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Doi
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Konishi
authors.forename: Shuta
authors.initials: S
authors.lastname: Tsuboi
authors.forename: Manabu
authors.initials: M
authors.lastname: Ogita
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Dohi
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tamura
authors.forename: Shinya
authors.initials: S
authors.lastname: Okazaki
authors.forename: Kikuo
authors.initials: K
authors.lastname: Isoda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000639:trends*; D011183:Postoperative Complications; D051437:Renal Insufficiency / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome