In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

This content is currently on FREE ACCESS, enjoy another 47 days of free consultation


Impact of chronic kidney disease on clinical outcomes in patients with unprotected left main coronary artery disease: insights from a large-sized all-comers registry

Session Poster Session 7

Speaker Assistant Professor Dae-Won Kim

Congress : ESC Congress 2019

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Coronary Intervention: Stents
  • Session type : Poster Session
  • FP Number : P6528

Authors : DW Kim (Daejon,KR), SH Her (Daejon,KR)

DW Kim1 , SH Her1 , 1Daejon St. Mary's Hospital, Division of Cardiology - Daejon - Korea (Republic of) ,

On behalf: the IRIS-MAIN Registry Investigators


Aims: Clinical outcomes according to the status of renal insufficiency were not fully evaluated in patients with significant left main coronary artery disease (LMCAD).

Methods and results: The current study analyzed 4894 patients with unprotected LMCAD enrolled in the multicenter IRIS-MAIN registry. Renal insufficiency was graded according to the baseline renal function (eGFR). The primary clinical outcome was major adverse cardiocerebrovascular event (MACCE), defined as a composite of death, myocardial infarction, stroke, and any revascularization. At baseline, 3824 (78%) had preserved renal function (eGFR =60 ml·min -1·1.73m-2), 838 (17%) had moderate renal dysfunction (eGFR of = 30 and <60), and 232 (5%) had severe renal dysfunction (eGFR <30). At 2 years, the rates of MACCE were significantly higher in patients with lower levels of eGRF (9.1% in eGRF =60, 16.0% in eGFR of = 30 and <60, and 36.2% in eGRF <30, respectively, P<0.001). After multivariable adjustment, as compared with patients with eGFR = 60, the hazard ratios (HR) for MACCE proportionally increased for patients with eGFR of = 30 and <60 (HR 1.46, 95% CI 1.18-1.79) and for those with eGFR <30 (HR 3.39, 95% CI 2.61-4.40). The adjusted risks for MACCE was similar between percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG) in patients with preserved and moderate renal dysfunction. However, in patients with severe renal dysfunction, PCI was associated with a significantly higher risk of MACCE compared to CABG (38.5% vs. 24.7%, HR 1.80, 95% CI 1.03-3.13, P=0.04).

Conclusions: The degree of renal insufficiency was proportionately associated with worse clinical outcomes in patients with LMCAD. In patients with severe renal dysfunction of eGFR of <30, PCI was associated with a higher risk of MACCE as compared with CABG.

2-Year Event Rate, n (%)

Crude Risk

Adjusted Risk*

Patient Groups

Revascularization type


95% CI

P value


95% CI

P value


CABG (reference)

All patients

306/2825 (10.8)

144/1453 (9.9)







Subgroups by

baseline eGFR

Preserved renal function

(eGFR >60)

190/2289 (8.3)

89/1098 (8.1)







Moderate renal dysfunction

(eGFR ≥ 30 and <60)

71/419 (169%)

37/282 (13.1%)







Severe renal dysfunction

(eGFR <30)

45/117 (38.5%)

18/73 (24.7%)







Crude and Adjusted Risk of Primary Composite Outcome After PCI and CABG, According to the Status of Baseline Renal Function.

This content is currently on FREE ACCESS, enjoy another 47 days of free consultation


Based on your interests

Members get more

Join now
  • 1ESC Professional Members – access all resources from ESC Congress and ESC Asia with APSC & AFC
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s congress resources
  • 3Under 40 or in training - with a Combined Membership, access resources from all congresses
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are