Letters to the Editor Renal function and drug-eluting stent Carlo Briguori a,b, ⁎ , Flavio Airoldi c , Alaide Chieffo b , Mauro Carlino b , Matteo Montorfano b , Antonio Colombo b a Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy b Laboratory of Interventional Cardiology, “Vita e Salute” University School of Medicine, San Raffaele Hospital, Milan, Italy c Laboratory of Interventional Cardiology, IRCCS Multimedica, Milan, Italy Received 19 November 2008; accepted 22 November 2008 Available online 15 January 2009 Keywords: Chronic kidney disease; Drug eluting stent; Outcome At present, limited data are available on the long-term outcome following DES implantation in patients with CKD [1–5]. From April 2002 to January 2004, 2314 consecutive patients underwent implantation of sirolimus-eluting stents or paclitaxel-eluting stents at our Institutions. Estimated glomerular filtration rate (eGFR) was calculated by applying the Level modified Modification of Diet in Renal Disease (MDRD) formula [6]. All patients were treated with ticlopidine or clopidogrel (for at least 6 months) and aspirin (indefinitely). Major adverse cardiac events (MACE), including all cause death, myocardial infarction (MI) and repeat revascularization, were assessed. Stent thrombosis (ST) was classified according to the ARC criteria [7]. According to the eGFR, 4 groups were identified: 1) severe CKD group (eGFR b 30 ml/min/1.73 m 2 ; n = 24), 2) moderate CKD group (eGFR 30–59 ml/min/1.73 m 2 ; n =342), 3) mild CKD group (eGFR 60–89 ml/min/1.73 m 2 ; n =1502), and 4) preserved renal function or no-CKD group (eGFR ≥ 90 ml/ min/1.73 m 2 ; n = 446) [6]. In-hospital MACE rate was higher in the severe CKD group, due to a higher rate of in-hospital death (Table 1). At 24 months, the cumulative MACE rate, although not statistically different, was higher in the Severe CKD group (Figs. 1 and 2). The independent predictors of death and MI at follow-up are reported in Table 2. The major conclusions of the present study, providing the 2-year clinical outcomes following DES implantation in a large, unselected population of patients stratified according to renal function, are 1) CKD occurs in approximately 16% of patients undergoing DES implantation, 2) severe CKD identifies patients at high risk of in-hospital and long-term hard cardiovascular events, 3) the rate of clinical restenosis does not seem to be affected by the renal function, and 4) the rate of ST seems to be higher in patient with severe CKD. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [8]. References [1] Lemos PA, Arampatzis CA, Hoye A, et al. Impact of baseline renal function on mortality after percutaneous coronary intervention with sirolimus-eluting stents or bare metal stents. Am J Cardiol 2005;95(2):167–72. [2] Das P, Moliterno DJ, Charnigo R, et al. Impact of drug-eluting stents on outcomes of patients with end-stage renal disease undergoing percutaneous coronary revascularization. J Invasive Cardiol 2006;18(9):405–8. [3] Halkin A, Mehran R, Casey CW, et al. Impact of moderate renal insufficiency on restenosis and adverse clinical events after paclitaxel- eluting and bare metal stent implantation: results from the TAXUS-IV Trial. Am Heart J 2005;150(6):1163–70. [4] Jeong YH, Hong MK, Lee CW, et al. Impact of significant chronic kidney disease on long-term clinical outcomes after drug-eluting stent versus bare metal stent implantation. Int J Cardiol 2008 Mar 28;125(1):36–40. [5] Mishkel GJ, Varghese JJ, Moore AL, Aguirre F, Markwell SJ, Shelton M. Short- and long-term clinical outcomes of coronary drug-eluting stent recipients presenting with chronic renal disease. J Invasive Cardiol 2007;19(8):331–7. [6] K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39 (2 Suppl 1):S1–S266. [7] Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007;115(17):2344–51. [8] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131: 149–50. International Journal of Cardiology 142 (2010) 92 – 109 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Interventional Cardiology, Clinica Mediterranea, Via Orazio, 2, I-80121, Naples, Italy. Tel.: +39 0817259 764; fax: +39 0817259 724. E-mail address: briguori.carlo@hsr.it (C. Briguori).