Diabetic nephropathy, percutaneous coronary interventions, and blockade of the renin-angiotensin system

Since recent studies demonstrated an impaired outcome after percutaneous coronary interventions (PCI) in patients with chronic renal failure but did not address the aetiology of renal failure, we now analysed the outcome of patients with diabetic nephropathy in 721 consecutive patients Undergoing PCI. Diabetic nephropathy was present in 37 patients (5.1 %), and diabetes alone in 126 patients (17.5 %); 178 patients (24.7 %) suffered from renal insufficiency of other causes; the other 380 patients (52.7 %) were used as controls. Although angiographic success rates were similar in the subgroups (94-97 %), 30-day and long-term mortality after 4 years was significantly higher in patients with diabetic nephropathy (8.1 and 27 %, respectively) than in diabetics (1.6 and 8.7 %, respectively), patients with renal insufficiency (3.9 and 16.8 %, respectively), or controls (2.4 and 5.0 %, respectively, each p < 0.001, log-rank test). Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a marked decrease in 2-year mortality in patients with diabetic nephropathy (19.4 vs. 33.3 %, respectively, p = 0.02, logrank test).