The impact of renal dysfunction on the long term clinical outcomes of diabetic patients undergoing percutaneous coronary intervention in the drug-eluting stent era

Background Limited data are available regarding the association between renal dysfunction and clinical outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) in the drug-eluting stent (DES) era. Methods Between March 2003 and December 2010, 2,181 diabetic patients were enrolled in a single-center registry. We divided diabetic patients into a renal dysfunction group (n =518) and a non-renal dysfunction group (n =1,663) according to a baseline estimated glomerular filtration rate <60 mL/min/1.73 m2. Propensity score matching analysis was also performed. The primary outcome was cardiac death. Results The median follow-up duration was 48 months. The rate of cardiac death was higher in the renal dysfunction group than in the non-renal dysfunction group (14.3% vs. 3.0%, adjusted hazard ratio [HR] 3.63, 95% confidence interval [CI] 2.47 to 5.35, p<0.001). Similarly, the incidence of stent thrombosis was significantly higher in the renal dysfunction group than in the non-renal dysfunction group (4.1% vs. 1.4%, adjusted HR 1.90, 95% CI 1.02 to 3.56, p =0.04). After 1:1 propensity score matching (502 pairs), patients with renal dysfunction still had a higher rate of cardiac death (13.3% vs. 4.8%, HR 2.58, 95% CI 1.52 to 4.38, p<0.001) although there was no significant difference in the rate of stent thrombosis (4.0% vs. 2.8%, HR 1.31, 95% CI 0.64 to 2.69, p =0.47). Conclusions Renal dysfunction is associated with long-Term mortality for diabetic patients undergoing PCI in the DES era.