Background:The prognostic value of angiographic complete revascularization in patients with chronic kidney disease (CKD) has not been thoroughly investigated, especially for contemporary coronary stents. We compared the clinical outcomes of complete and incomplete revascularization with second-generation drug-eluting stent, according to the presence of CKD.Methods:From the Grand Drug-Eluting Stent Registry (N=17 286) in Korea, we selected 8471 patients, who were treated with second-generation drug-eluting stent and had glomerular filtration rate and quantitative coronary angiography data (3014 [35.6%] patients with CKD and 5457 (64.4%) patients with preserved renal function). Angiographic complete revascularization was defined as a residual SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) of 0. The primary outcome was the patient-oriented composite outcome at 3 years, including all-cause death, any myocardial infarction, and any revascularization.Results:The patient-oriented composite outcome rate after complete revascularization was significantly lower than that after incomplete revascularization in patients with CKD (14.6% versus 21.8%; adjusted hazard ratio, 0.79; 95% CI, 0.64–0.96; P=0.020) and in patients with preserved renal function (8.0% versus 12.0%; adjusted hazard ratio 0.77; 95% CI, 0.63–0.94; P=0.011). The cutoff values of residual SYNTAX scores for predicting better patient-oriented composite outcomes were different according to the presence of CKD, that is, <3 and <8 in patients with CKD and with preserved renal function, respectively.Conclusions:Angiographic complete revascularization led to better clinical outcomes in patients with CKD and with preserved renal function. However, the residual SYNTAX score to achieve a better outcome was lower in patients with CKD than with preserved renal function, favoring more aggressive revascularization in patients with CKD.

中文翻译：

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慢性肾脏病患者使用当代冠状动脉支架完全血运重建后的更好预后。

背景：血管造影完全血运重建术对慢性肾脏疾病（CKD）患者的预后价值尚未得到彻底研究，尤其是对于当代冠状动脉支架。根据CKD的存在，我们比较了使用第二代药物洗脱支架进行完全和不完全血运重建的临床结果。方法：从韩国的药物洗脱支架注册中心（N = 17 286）中，我们选择了8471例患者，使用第二代药物洗脱支架治疗并具有肾小球滤过率和定量冠状动脉造影数据的患者（3014例[35.6％] CKD患者和5457例（64.4％）肾功能保留患者）。血管造影术完全血运重建的定义为残留SYNTAX得分（经红细胞的经皮冠状动脉介入治疗与心脏外科手术之间的协同作用）为0。P = 0.020）和肾功能保留的患者（8.0％比12.0％；调整后的危险比0.77； 95％CI，0.63-0.94；P = 0.011）。根据CKD的存在，剩余SYNTAX评分的临界值根据患者的CKD的存在而有所不同，即CKD和肾功能保持正常的患者分别<3和<8。以改善CKD并保留肾功能的患者的临床结局。但是，CKD患者获得更好结局的残余SYNTAX评分低于肾功能保留患者，这有利于CKD患者更积极的血运重建。