Prognostic Value of Chronic Kidney Disease in Acute Coronary Syndrome Patients Treated with Percutaneous Coronary Intervention

Objective: Impact of renal impairment (RI) on short&long term outcome of percutaneous coronary intervention (PCI) in patients with ACS. Methods: 427 patients with ACS, treated with PCI .They were classified into 4 groups (normal , mild, moderate and severe renal impairment) based on creatinine clearance (eCrCl).MACE including death, new myocardial infarction (MI) and target vessel revascularization (TVR) were recorded during early (30 days) and late for average 49months. Results: Patients with severe RI had   higher number of vessels affected (p 0.023), lower grade of  TIMI flow(p0.029), lower percent dilatation of culprit lesion( p<0.001), less frequent use of GPIIb/IIIa inhibitors(p0.002) and more frequent need for TVR(p0.03). eCrCl had  positive correlation with EF and percent dilatation of  stenotic lesion (p,0.001)and   negative correlation with number of vessels & late MACE(p0.001).Patients with severe RI had increase in frequency of lateMACE compared to other groups(p0.001).TypeC lesions were more common in patients with advanced RI(p0.03).MACE free survival showed significant decline matching the decline in eCrCl among study groups. Conclusion: PCI outcome in patients with severe RI was suboptimal.They had increased riskof TVR within one month and increased riskof MI,death and total MACE on the long term.