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Background  There are limited data regarding the prognostic impact of angiographic complete revascularization ( CR ) in patients with chronic kidney disease ( CKD ). We sought to investigate the differential prognostic impact of angiographic  CR  over incomplete revascularization ( IR ), according to the presence of  CKD  in the drug‐eluting stent era.    Methods and Results  Between 2003 and 2011 at Samsung Medical Center, consecutive patients with multivessel disease were stratified by the presence of  CKD  (estimated glomerular filtration rate <60 mL/min per 1.73 m 2 ) and classified according to angiographic  CR  (residual  SYNTAX  score=0) or  IR . Clinical outcomes were compared between angiographic  CR  and  IR , stratified by the presence of  CKD . Primary outcome was patient‐oriented composite outcomes ( POCO , a composite of all‐cause death, myocardial infarction, any revascularization) at 3 years. Inverse probability weighting was performed between the  CR  and  IR  groups. A total of 3224 patients were eligible for analysis: 2295 without  CKD ; 929 with  CKD . Among non‐ CKD  patients, angiographic  CR  showed a significantly lower risk of  POCO  than  IR  (17.2% versus 21.7%, adjusted hazard ratio 0.76, 95% confidence interval, 0.62–0.95,  P =0.014), mainly driven by a significantly lower risk of any revascularization. Among  CKD  patients, however, angiographic  CR  was associated with a significantly higher risk of  POCO  than  IR  (37.7% versus 28.4%, adjusted hazard ratio 1.42, 95% confidence interval, 1.08%–1.85%,  P =0.011), mainly driven by a significantly higher risk of nonfatal target vessel myocardial infarction.    Conclusions  Angiographic  CR  was associated with reduced risk of  POCO  than  IR  in patients without  CKD ; however, it was associated with a significantly higher risk of  POCO  and nonfatal myocardial infarction in  CKD  patients.

journal of the american heart association

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era