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PERCUTANEOUS INTERVENTION AND RENAL DYSFUNCTION

Impact of mild or moderate chronic kidney disease on the frequency of restenosis

Results from the PRESTO trial

Patricia J.M. Best, MD^*,*, Peter B. Berger, MD, Barry R. Davis, MD, PhD, Cindy L. Grines, MD, H. Mehrdad Sadeghi, MD, Brent A. Williams, MS^*, James T. Willerson, MD^||, Jeffrey R. Granett, MD^¶, David R. Holmes, Jr, MD^* PRESTO Investigators

^* Mayo Clinic, Rochester, Minnesota, USA
Duke University, Durham, North Carolina, USA
University of Texas School of Public Health, Houston, Texas, USA
William Beaumont Hospital, Royal Oak, Michigan, USA
^|| University of Texas Medical School and Texas Heart Institute, Houston, Texas, USA
^¶ GlaxoSmithKline, Collegeville, Pennsylvania, USA

Manuscript received February 20, 2004; revised manuscript received July 6, 2004, accepted July 12, 2004.

^* Reprint requests and correspondence: Dr. Patricia J. M. Best, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (Email: best.patiricia{at}mayo.edu).

OBJECTIVES: The goal of this study was to determine if restenosis is increased in mild and moderate chronic kidney disease (CKD) patients after percutaneous coronary intervention (PCI).

BACKGROUND: Mortality is increased in CKD after PCI. Restenosis may contribute to increased late mortality.

METHODS: We analyzed 11,187 patients with a creatinine <1.8 mg/dl from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial, grouped by estimated creatinine clearance (CrCl) (<60, 60 to 89, >89 ml/min). The Cox proportional hazards models investigated the association between CrCl group and death, myocardial infarction, and target vessel revascularization (TVR). Generalized estimating equation regression models determined the association between CrCl group and lesion-specific restenosis.

RESULTS: At 30 days, there was no difference in myocardial infarction, death, or TVR between the CrCl groups. At nine months, mortality was higher in the lowest CrCl group (2.2%, 1.2%, 0.8%; p < 0.001), which was no longer significant after adjusting for confounding variables. Myocardial infarction and TVR were not different between the groups. In patients undergoing protocol follow-up angiography, restenosis (50%) was not increased with CKD (32%, 32%, 37%; p = 0.02).

CONCLUSIONS: Mortality nine months after PCI is mildly increased in mild or moderate CKD patients. However, restenosis is not and does not account for the increased mortality.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CHF = congestive heart failure   CKD = chronic kidney disease   CrCl = creatinine clearance   HR = hazard ratio   MI = myocardial infarction   PCI = percutaneous coronary intervention   PRESTO = Prevention of REStenosis with Tranilast and its Outcomes trial   TVR = target vessel revascularization

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