Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease.

BACKGROUND: There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events. METHODS: All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. RESULTS: Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3-8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group. CONCLUSIONS: During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.

[Effects of preoperative uses of aspirin and clopidogrel on patients undergoing coronary artery bypass graft surgery].

OBJECTIVE: To analyze the effects of preoperative uses of aspirin and clopidogrel on perioperative blood loss and blood transfusion requirements and complication in patients undergoing off-pump coronary artery bypass graft (CABG). METHODS: At our hospital from October 2011 to October 2012, a total of 480 patients underwent off-pump CABG performed by the same surgical team. Among them, 198 patients continued aspirin (discontinued clopidogrel at least 5 days) through operation (aspirin group, 1), 53 had aspirin and clopidogrel until 3 days before surgery (aspirin and clopidogrel group, 2) and 229 discontinued antiplatelet therapy 5 more days before surgery (control group, 3). RESULTS: No significant difference of basic clinical characteristics existed among three groups (P > 0.05). Group 2 was associated with a greater volume of chest tube drainage than other groups (827 ± 216 vs 416 ± 135 vs 265 ± 85 ml, P < 0.05). There was no significant difference between groups 1 and 3, even though chest tube drainage volume of group 1 was greater (827 ± 216vs 265 ± 85 ml, P > 0.05). There was no instance of stroke, myocardial infarction or post-operative mortality. CONCLUSION: Preoperative clopidogrel exposure within 5 days of surgery increases perioperative blood loss. And the pre-operative use of aspirin results in no difference in postoperative perioperative blood loss and cardiovascular outcomes.

Graft occlusion after coronary artery bypass grafting and stent deformation and in-stent restenosis after succedent stenting in a patient with deep position myocardial bridging.

We present a case of deep position myocardial bridging in a patient who had early graft occlusion after coronary artery bypass grafting and had stent deformation and in-stent restonesis after succedent stenting.

Coronary stenting versus bypass surgery in heart failure patients with preserved ejection fraction.

BACKGROUND: The optimal revascularization strategy in patients with heart failure with preserved ejection fraction (HFPEF) remains unclear. The aim of the present study was to compare the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with HFPEF. METHODS: From July 2003 through September 2005, a total of 920 patients with coronary artery disease (CAD) and HFPEF (ejection fraction ≥ 50%) underwent PCI (n = 350) or CABG (n = 570). We compared the groups with respect to the primary outcome of mortality, and the secondary outcomes of main adverse cardiac and cerebral vascular events (MACCE), including death, myocardial infarction, stroke and repeat revascularization, at a median follow-up of 543 days. RESULTS: In-hospital mortality was significantly lower in the PCI group than in the CABG group (0.3% vs. 2.5%, adjusted P = 0.016). During follow-up, there was no significant difference in the two groups with regard to mortality rates (2.3% vs. 3.5%, adjusted P = 0.423). Patients receiving PCI had higher MACCE rates as compared with patients receiving CABG (13.4% vs. 4.0%, adjusted P < 0.001), mainly due to higher rate of repeat revascularization (adjusted P < 0.001). Independent predictors of mortality were age, New York Heart Association (NYHA) class and chronic total occlusion. CONCLUSION: Among patients with CAD and HFPEF, PCI was shown to be as good as CABG with respect to the mortality rate, although there was a higher rate of repeat revascularization in patients undergoing PCI.

Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease.

BACKGROUND: In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG) in the patients with CTO and multivessel disease. METHODS: From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n = 679) or DES (n = 267) treatment. Their propensity risk score was used for adjusting baseline differences. RESULTS: At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95%CI 1.219 - 3.179, P = 0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95%CI 5.739 - 45.391, P < 0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points. CONCLUSIONS: Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

Off-pump coronary artery bypass grafting with device closure of atrial septal defect.

Patients with coronary artery disease and atrial septal defect may have unique clinical characters. We describe an off-pump combined approach for intraoperative device closure of atrial septal defect during coronary artery bypass grafting.

Coronary artery bypass grafting in adults with congenital heart disease.

BACKGROUND: Adults with congenital heart disease (CHD) and coronary artery disease (CAD) have unique clinical manifestation due to the coexistence of intracardiac anomalies and CAD. Case reports are rare in surgical management of CHD combined with CAD. Our goal is to study the outcome of surgical intervention of CHD and CAD concomitantly. METHODS: From February 2002 to August 2009, 29 adult patients underwent coronary artery bypass grafting (CABG) and surgical correction of CHD concomitantly. Congenital cardiac anomalies include atrial septal defect (ASD) in 21 cases, ventricular septal defect in four cases, atrioventricular septal defect in three cases, and cor triatriatum in one case. Coronary angiography demonstrated: one-vessel disease in 10 cases, two-vessel disease in 11 cases, and three-vessel disease in eight cases. Coronary revascularization and intracardiac anomalies were corrected with cardiopulmonary bypass in 23 cases. There were six patients who had off-pump coronary artery pass grafting (OPCAB) and intraoperative device closure of ASD. RESULTS: One patient died of pulmonary infection and multiorgan failure. Follow-up time was from 2 to 89 months (mean, 42 ± 25 months). One patient with recurrent angina did not need intervention of the revascularization. Six patients who acquired OPCAB and intraoperative device closure of ASD had no complications after surgery. CONCLUSIONS: Surgery for adult patients who had CHD with CAD was a safe and effective management. OPCAB with intraoperative device closure of ASD was a reasonable approach for some selective patients.

Prognostic value of baseline C-reactive protein levels in patients undergoing coronary revascularization.

BACKGROUND: C-reactive protein (CRP) is a lowly expressed marker for inflammatory response. This study aimed to evaluate the prognostic value of baseline CRP levels in patients undergoing coronary revascularization in the context of modern medical treatment. METHODS: This was a retrospective study in a single center. Four hundred and fourteen patients were enrolled, who underwent coronary revascularization and received adequate medication for secondary prevention of coronary heart disease. The study compared the follow-up clinical outcomes between high level CRP group (CRP > 5 mg/L) and low level one. The median follow-up time was 551 days. RESULTS: Compared with low CRP group, the relative risk (RR) of the major adverse cardiovascular and cerebral events (MACCE) in high CRP group was 5.131 (95%CI: 1.864-14.123, P = 0.002). There were no significant differences in death, myocardial infarction and stroke during the follow-up between two groups, but a higher risk of re-revascularization was found in high CRP group (RR 6.008, 95%CI: 1.667-21.665, P = 0.006). Cox regression analysis showed that only CRP level could contribute to MACCE during the follow-up. MACCE-free rate was much lower in high CRP group (Kaplan-Meier log-rank P < 0.001). CONCLUSION: In the context of modern medical treatment, the baseline level of CRP is an independent predictor for long-term prognosis in patients with coronary revascularization.

[Impact of overweight on clinical outcomes in patients undergoing coronary revascularization].

OBJECTIVES: To determine the impact of BMI on clinical outcome in patients with heart failure underwent coronary revascularization. METHODS: The DESIRE-plus (Drug-Eluting Stent Impact on Revascularization-plus) was a single-center registry of coronary revascularization in our institution between July 1, 2004 and September 30, 2005. We analyzed heart failure patients with the complete data of body mass index (BMI) data from the DESIRE-plus trial and grouped them by BMI (normal BMI group, BMI < 24; overweight group, BMI 24-27.9; obesity group, BMI > or = 28). Total mortality, cardiac mortality and MACCE including death, neo-myocardial infarction, stroke, re-revascularization were recorded. We evaluated risk estimates for three bodyweight groups. RESULTS: 1010 patients were included in the study (295 in normal BMI group; 495 in overweight group and 220 obesity group). Median follow-up was 542 days. Overweight and obese patients were younger (59.3 +/- 10.14 years, 58.6 +/- 10.30 years vs 62.6 +/- 9.93 years, P < 0.01) and had a significantly higher incidence of hypertension (61.2, 66.8% vs 52.5%, P = 0.017), stable angina pectoris (21.2%, 23.7% vs 17.0%, P = 0.05) and higher triglyceride [(1.90 +/- 1.05) mmol/L, (2.10 +/- 1.12) mmol/L vs (1.48 +/- 0.92) mmol/L, P < 0.01)], fasting blood glucose level [(6.07 +/- 2.09) mmol/L, (5.96 +/- 1.53) mmol/L vs (5.67 +/- 1.92) mmol/L, P = 0.021), blood creatinine (84.9 +/- 21.7) micromol/L, (90.2 +/- 30.9) micromol/L vs (82.2 +/- 25.8) micromol/L, P = 0.002] compared with normal BMI patients. Multivariate Cox regression model showed obese patients had an decreased hazard risk (HR) for total mortality (0.285, 95%CI 0.104 - 0.777) and MACCE (0.596, 95%CI 0.401 - 0.885) compared with those for patients with normal BMI, overweight patients had no increased risk for total mortality (HR 0.769, 95%CI 0.442 - 1.338) and MACCE (0.998, 95%CI 0.754 - 1.322), there was hardly any significantly difference in cardiac mortality between three groups (P = 0.223). CONCLUSION: There were more risk factors in heart failure patients with coronary heart disease complicated with obesity or overweight, but the prognosis after revascularization of them is at least no worse than the normal weight coronary heart disease patients.

Cannulation of the innominate artery with a side graft in arch surgery.

BACKGROUND: The purpose of this study was to examine the safety and efficacy of cannulation of the innominate artery with a side graft in arch surgery. METHODS: Between January 2004 and March 2009, 46 patients received arch surgery under hypothermia circulatory arrest (HCA) and hemispheric antegrade cerebral perfusion (HACP). There were 36 men and 10 women with an average age of 48.0 +/- 12.8 years. Thirty-four patients had type A aortic dissection. Four patients had type B aortic dissection. The remaining 8 patients had aortic aneurysm involving the ascending aorta and arch. The innominate artery was free of diseases in all patients. The diameter of the innominate artery was 12.1 +/- 1.6 mm (range, 9 to 16 mm). An 8-mm vascular graft, which was anastomosed to the innominate artery in an end-to-side manner, was used for arterial cannulation. Ascending aorta and arch replacement in combination with open stent-graft implantation was conducted in 42 patients. Four patients received open stent-graft implantation through the aortic arch only. RESULTS: The aortic cross-clamp time was 87.2 +/- 36.0 minutes. The lowest nasopharyngeal temperature was 21.0 +/- 3.6 degrees C. The HCA and the HACP time was 29.6 +/- 14.0 minutes. The HACP flow was 8.3 +/- 2.3 mL x kg(-1) x min(-1). Five patients (10.9%) had temporary postoperative neurologic dysfunction. There was no permanent neurologic dysfunction. Three patients died within 30 days postoperatively, and the 1-month mortality rate was 6.5%. All of the surviving patients were followed for 24.9 +/- 18.0 months (range, 1 to 63). There were no deaths or severe complications during the follow-up. CONCLUSIONS: Cannulation of the innominate artery with a side graft is safe and effective in arch surgery.

Early and midterm results of thoracic endovascular aortic repair of chronic type B aortic dissection.

OBJECTIVE: The optimal treatment for chronic type B dissection remains controversial. This study reports early and midterm results of thoracic endovascular aortic repair for chronic type B aortic dissection. METHODS: From June 2001 to September 2007, a total of 84 patients with chronic type B aortic dissection underwent thoracic endovascular aortic repair. The time between onset of dissection and thoracic endovascular aortic repair was 13.9 +/- 22.0 months (range, 1-120 months). All patients were followed up from 6 to 86 months (mean, 33.2 +/- 19.2 months). RESULTS: The entry tear was completely sealed in 77 cases (91.7%) during thoracic endovascular aortic repair. The incidence of incomplete seal was 8.3%. The 1-month mortality was 1.2%. One patient had retrograde type A dissection 1 month after the operation. Four patients underwent a second thoracic endovascular aortic repair during follow-up, for endoleak in 3 patients and for newly formed intimal tear in 1 patient. Seven patients (8.3%) died during follow-up. Three died of rupture of the thoracic aorta because of endoleak. The Kaplan-Meier actuarial survival curve showed a 5-year survival of 84.4%. At 5 years, 75.2% of patients were alive with neither endoleak nor reintervention. CONCLUSIONS: Early and midterm results show that thoracic endovascular aortic repair was effective in the treatment of chronic type B aortic dissection. Endoleak was the main cause of death during follow-up. With increased surgical experience and refinement of the stent graft, results are likely to improve in the future.

[The early and middle-long term clinical results of surgical treatment for ventricular septal rupture].

OBJECTIVE: To explore the way of promoting the efficacy of surgical treatment for ventricular septal rupture (VSR) after acute myocardium infarction in terms of perioperative and long term survival. METHODS: The clinic data of 37 VSR cases underwent surgical treatment from October 1994 to October 2007 were analyzed retrospectively. There were 24 male and 13 female, and the age was (63.4 +/- 7.6) years old. The whole group was divided into the VSR repair plus revascularization group (group A, 26 cases) and simple VSR repair group (group B, 11 cases). RESULTS: There were 4 operative deaths in group A (15.4%), 7 deaths in group B (63.6%), P = 0.006. With the follow-up of (34.0 +/- 29.8) months ranged from 2 to 103 months of the 26 operational survivors, there were 5 late deaths, of which 2 deaths in group A and 3 deaths in group B. According to the Kaplan-Meier survival curve, the actuarial survival rate at 6 to 8 year was (64.3 +/- 21.0)% for group A and the actuarial survival rate at 4 year was (25.0 +/- 21.7)% for group B, P = 0.011. Of the 21 mid-long term survivors, 17 cases were in NYHA class I to II and 4 cases in NYHA class III to IV. There were 4 cases suffered from VSR recurrence. According to Logistic regression, the risk factors for the early death were not adoptive of revascularization, cardiogenic shock and emergency surgical procedure, while the risk factors for late death were not adoptive of revascularization and low cardiac output after the procedures. CONCLUSIONS: VSR repair plus revascularization could improve the perioperative and mid-long term survival for the surgical treatment of VSR. The appropriate timing and procedures of the surgical operation are very important to promote perioperative survival and to prevent VSR recurrence.

Complications of open stent-graft in treatment of aortic dissection.

Open stent-graft has been used in the treatment of aortic dissection in recent years. Two device related complications happened in two patients. One was stenosis of the true lumen in the descending aorta caused by infolding of the distal end of the stent-graft immediately after its deployment. The other one was a new intima tear at the distal end of the stent-graft caused by full expansion of the stent-graft two years after stent-graft implantation. With the refinement of the device and enrichment of surgeons' experience, such complications could be avoided in the future.

Endovascular repair after stent elephant trunk procedure for extensive thoracic aortic aneurysm.

Hybrid surgical-endovascular procedure was conducted in a 46-year-old male with extensive thoracic aortic aneurysm. Ascending aorta and arch replacement combined with stent elephant trunk implantation was performed first. An open stent-graft was implanted into the descending aorta. One month later, endovascular repair was conducted. Postoperative CTA showed total coverage of the descending aorta by stent-grafts and the descending aortic aneurysm was totally thrombo-excluded. Stent elephant trunk may be a better alternative to conventional elephant trunk in hybrid surgical-endovascular approaches in treatment of extensive thoracic aortic aneurysm.

A study of aortic dimension in type B aortic dissection.

Difference between arch diameter and true lumen diameter in the descending aorta was studied in patients with type B aortic dissection. The diameters of the aortic arch (Proximal ) and mid-descending aorta (Distal ) were measured on computer tomography angiography (CTA) in 20 healthy adults. Forty-two patients with type B aortic dissection who underwent endovascular repair were divided into two groups: an acute group (23 patients) and a chronic group (19 patients). The diameters of the arch (Proximal ) and the true lumen of the mid-descending aorta (Distal ) were measured on digital subtraction angiography (DSA) and CTA. The taper ratio was defined as (Proximal -Distal )/(Proximal )x100%. In the control group, the taper ratio was 13.0+/-4.7% on CTA. In the acute patients group, the taper ratio was 23.6+/-11.3% on DSA and 21.9+/-12.1% on CTA. In the chronic patients group, the taper ratio was 31.5+/-13.6% on DSA and 30.1+/-11.4% on CTA. In both acute and chronic type B aortic dissection, the aorta tapers significantly from arch to true lumen in the descending aorta. Stent-graft with tapered design may be a viable treatment option for endovascular repair of type B aortic dissection.

[Impact of chronic anemia on in-hospital clinical outcome of revascularization in patients with coronary artery disease].

OBJECTIVE: To evaluate the in-hospital clinical outcome of revascularization in patients with coronary artery disease with chronic anemia. METHODS: Between July 2002 and June 2004, 3 679 patients in Anzhen Hospital Affiliated to Capital University of Medical Sciences were subjected to revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)] during hospitalization. These patients were divided into anemia group and non-anemia group according to blood hemoglobin (Hb) level [World Health Organization (WHO) standard (male<120 g/L, female<110 g/L) as anemia]. Rates of in-hospital main adverse cardiac and cerebral events (MACCE), including all-cause death, new attack of myocardial infarction, stroke and repeated revascularization were compared between two groups. RESULTS: There were 426 anemia patients (11.6%) and 3 253 non-anemia patients (88.4%). In-hospital death in the anemia group was higher than that of the non-anemia group [10 cases (2.4%) vs. 64 cases (1.9%), P<0.05]. Rates of MACCE of the anemia group was higher than that of the non-anemia group (4.2% vs. 3.2%, P<0.05). There was no significant difference in rates of new attack of myocardial infarction (0.7% vs. 0.6%), stroke (1.2% vs. 0.4%) and repeated revascularization (0 vs. 0.2%) between two groups (all P>0.05). CONCLUSION: Compared with non-anemia patients, anemia patients with coronary artery disease has higher in-hospital MACCE rate and all-cause mortality.

[Risk factors related to mortality in old patients with coronary heart disease after revascularization].

OBJECTIVE: To evaluate the risk factors related to mortality in old patients with coronary heart disease after revascularization. METHODS: A total of 675 patients (498 males) with age >or= 70 years old who received revascularization during July 2003 to June 2004 and followed up > 30 days after discharge were included in this study. Clinical characteristics, death and major adverse cardiac and cerebral events (MACCE) during follow up were recorded. RESULTS: The patients were followed up for a mean period of (754 +/- 355) days. 27 patients (4.0%) died and MACCE developed in 50 patients (7.4%) during follow up. Female and patients with anemia took a significantly higher risk of mortality (RR = 2.750, 95% CI 1.116 - 6.779, P = 0.028, RR = 0.385 95% CI 0.164 - 0.904, P = 0.028, respectively); Creatinine level is positively related to mortality rate. When comparing patients with Cr > 115 micromol/L and Cr > 177 micromol/L with patients with Cr < 115 micromol/L, the hazard rate was 2.963 and 10.785, respectively (95% CI 1.114 - 9.952, P = 0.035 and 95% CI 2.659 - 78.097, P = 0.000) after adjustment for other risk factors. CONCLUSION: Preexisting anaemia (male Hb < 120 g/L, female Hb < 110 g/L), renal insufficiency (Cr > 115 micromol/L) and female gender were found to be independent risk factors for mortality in old patients with coronary heart disease post revascularization.

[Outcome of endovascular stent graft placement in patients with acute thoracic aortic syndromes].

OBJECTIVE: To evaluate the outcome of endovascular stent graft placement in patients with acute thoracic aortic syndromes. METHODS: Emergency stent-graft implantations were performed in 57 patients with acute thoracic aortic syndromes from May 2001 to December 2005 (45 Stanford B aortic dissections, 9 acute penetrating aortic ulcers or pseudoaneurysms. 3 traumatic thoracic aneurysms). The clinical data, efficacy and follow-up results were analyzed. RESULTS: Procedures were successful in all patients. Type I endoleaks were evidenced in 5 patients and ascending aortic dissection occurred in 1 patient during operation, 5 patients with acute penetrating aortic ulcer complicating with coronary artery disease received successful PCI immediately post endovascular stent graft placement. Adynamia in extremities occurred in 1 patient and recovered two days later post anisodamine and mcnicol treatments. Left vertebral artery ischemia was found in 1 patient due to coated subclavian artery by stent-graft and the patient recovered spontaneously after two days lethargy without special treatment. The mean ICU time after surgery was 3.5 days (1 - 8 days) and the mean hospitalization time was 10 days. The mean follow-up time was 25.30 +/- 13.1 months (1 - 47 months). Two patients died within 30 days after operation, 1 patient died of rupture of the ascending aortic dissection (7 days post operation), 1 patient died of acute renal failure at the 2nd day post operation. One patient died of empsyxis 3 months after procedure, 1 patient died at the 4th month post procedure for unknown reason, 1 patient received second stent-graft implantation because of a newly formed endoleak at the proximal end of the stent-graft, 5 patients received second stent-graft implantation because of newly formed leaks at the remote end of the stent-graft. No paraplegia or stent migration or stenosis was observed during the follow up period. Total mortality during hospitalization and follow-up was 7.0%. CONCLUSION: Patients with acute thoracic aortic syndrome could be effectively and safely treated by coated stent-graft endovascular placement.

Prevalence and impact of renal insufficiency on clinical outcomes of patients undergoing coronary revascularization.

BACKGROUND: Patients with renal insufficiency are more likely to die after coronary revascularization, but mild renal insufficiency is neglected and little is known about its clinical effects. METHODS AND RESULTS: In the present study 3,025 patients grouped by estimated creatinine clearance (CrCl) were analyzed to evaluate the association between CrCl and clinical outcome. The mean serum creatinine was 1.0+/-0.4 mg/dl, with 4.3% above normal; in 65.8% CrCl was <90 ml/min. During hospitalization, there were significant differences in mortality among the groups stratified by CrCl (p<0.0001). During follow-up after hospital discharge, there were significant differences in mortality (p<0.0001), new-onset myocardial infarction (p=0.007), and stroke (p=0.032). In patients with severe renal insufficiency, the in-hospital and follow-up mortality reached 15.4% and 31.3%, respectively. The independent risk factors for all-cause death after revascularization were the mode of revascularization, age and the CrCl level. In patients with mild renal insufficiency or normal renal function, the all-cause mortality after percutaneous coronary intervention was significantly lower than that after CABG. CONCLUSIONS: Renal insufficiency is not rare in patients undergoing coronary revascularization and in the present study even mild renal insufficiency correlated with adverse clinical outcomes after revascularization. In patients with normal renal function or mild renal insufficiency, the mode of revascularization might lead to a prognostic difference.