***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —Although severe chronic kidney disease ( CKD ) is an independent predictor of mortality among patients with coronary artery disease , the impact of mild CKD on morbidity and mortality has not been fully defined . Methods and Results —Morbidity and mortality for the 3608 patients with multivessel coronary artery disease enrolled in the Bypass Angioplasty Revascularization Investigation r and omized trial and registry were compared on the basis of the presence and absence of CKD , defined as a preprocedure serum creatinine level of > 1.5 mg/dL. Seventy-six patients had CKD . Patients with renal insufficiency were older and more likely to have a history of diabetes , hypertension , and other comorbidities . Among patients undergoing PTCA , patients with CKD had a greater frequency of in-hospital death and cardiogenic shock ( P < 0.05 and 0.01 , respectively ) . There was a trend toward a larger proportion of patients with CKD experiencing angina at 5 years ( P = 0.079 ) . Patients with CKD had more cardiac admissions ( P = 0.003 and < 0.0001 for patients undergoing PTCA and CABG , respectively ) and a shorter time to subsequent CABG after initial revascularization than patients without CKD ( P = 0.01 ) . CKD was associated with a higher risk of death at 7 years , both of all causes ( relative risk 2.2 , P < 0.001 ) and of cardiac causes ( relative risk 2.8 , P < 0.001 ) . Conclusions —CKD is associated with an increased risk of recurrent hospitalization , subsequent CABG , and mortality . This increased risk of death is independent of and additive to the risk associated with diabetes OBJECTIVES We sought to determine whether low platelet response to the P2Y(12 ) receptor antagonist clopidogrel as assessed by vasodilator-stimulated phosphoprotein flow cytometry test ( VASP-FCT ) differentially affects outcomes in patients with or without chronic kidney disease ( CKD ) undergoing percutaneous coronary intervention ( PCI ) . BACKGROUND Although both CKD and impaired platelet responsiveness to clopidogrel are strong predictors of unfavorable outcome after PCI , the impact of their association is unknown . The platelet VASP-FCT assay is specific for the P2Y(12 ) ADP receptor pathway . In this test , platelet activation is expressed as the platelet reactivity index ( PRI ) . METHODS Four-hundred forty unselected patients ( CKD : 126 , estimated glomerular filtration rate [ eGFR ] < 60 ml/min/1.73 m(2 ) ) , no-CKD : 314 eGFR > 60 ml/min/1.73 m(2 ) ) undergoing urgent ( n = 336 ) or planned ( n = 104 ) PCI were prospect ively enrolled . In each subgroup , patients were classified as low-responders ( LR : PRI ≥ 61 % ) or responders ( R : PRI < 61 % ) to clopidogrel . RESULTS At a mean follow-up of 9 ± 2 months , all-cause mortality , cardiac death , and possible stent thrombosis were higher in CKD than in no-CKD patients . Within the CKD group , the LR status was associated with higher rates of all-cause mortality ( 25.5 % vs. 2.8 % , p < 0.001 ) , cardiac death ( 23.5 % vs. 2.8 % , p < 0.001 ) , all stent thrombosis ( 19.6 % vs. 2.7 % , p = 0.003 ) , and MACE ( 33.3 % vs. 12.3 % , p = 0.007 ) . Conversely , in no-CKD patients , the LR status did not affect outcomes . Multivariate analysis identified Killip class ≥ 3 , drug-eluting stent implantation , and the interaction between LR and CKD ( hazard ratio : 11.96 , 95 % confidence interval : 1.22 to 116.82 ; p = 0.033 ) as independent predictors of cardiac death . CONCLUSIONS In CKD patients , the presence of low platelet response to clopidogrel is associated with worse outcomes after PCI 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 infa rct ion , 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 infa rct ion , 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 infa rct ion 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 OBJECTIVES The goal of this study was to determine whether the level of kidney function  is an independent risk factor for atherosclerotic cardiovascular disease ( ASCVD ) outcomes in the Atherosclerosis Risk in Communities ( ARIC ) study , a prospect i ve cohort study of subjects aged 45 to 64 years . BACKGROUND The level of kidney function is now recognized as a risk factor for ASCVD outcomes in patients at high risk for ASCVD , but it remains unknown whether the level of kidney function is a risk factor for ASCVD outcomes in the community . METHODS Cox proportional-hazards regression was used to evaluate the association of glomerular filtration rate ( GFR ) with ASCVD after adjustment for the major ASCVD risk factors in 15,350 subjects . We search ed for nonlinear relationships between GFR and ASCVD . RESULTS During a mean follow-up time of 6.2 years , 965 ( 6.3 % ) of subjects had ASCVD events . Subjects with GFR of 15 to 59 ml/min/1.73 m(2 ) ( n = 444 , hazard ratio 1.38 [ 1.02 , 1.87 ] ) and 60 to 89 ml/min/1.73 m(2 ) ( n = 7,665 , hazard ratio 1.16 [ 1.00 , 1.34 ] ) had an increased adjusted risk of ASCVD compared with subjects with GFR of 90 to 150 ml/min/1.73 m(2 ) . Each 10 ml/min/1.73 m(2 ) lower GFR was associated with an adjusted hazard ratio of 1.05 ( 1.02 , 1.09 ) , 1.07 ( 1.01 , 1.12 ) , and 1.06 ( 0.99 , 1.13 ) for ASCVD , de novo ASCVD , and recurrent ASCVD , respectively . A nonlinear model did not fit the data better than a linear model . CONCLUSIONS The level of GFR is an independent risk factor for ASCVD and de novo ASCVD in the ARIC study Background — Patients with end-stage renal disease undergoing conventional balloon angioplasty  have reduced procedural success and increased complication rates . This study was design ed to determine the immediate and long-term outcomes of patients with varying degrees of renal failure undergoing percutaneous coronary intervention in the current device era . Methods and Results —We compared the immediate and long-term outcomes of 362 renal failure patients ( creatinine > 1.5 mg/dL ) with those of 2972 patients with normal renal function who underwent percutaneous coronary intervention between 1994 and 1997 . Patients with renal failure were older and had more associated comorbidities . They had reduced procedural success ( 89.5 % versus 92.9 % , P = 0.007 ) and greater in-hospital combined major event ( death , Q-wave myocardial infa rct ion , emergent CABG ; 10.8 % versus 1.8%;P < 0.0001 ) rates . Renal failure was an independent predictor of major adverse cardiac events ( MACEs ) ( OR , 3.41 ; 95 % CI , 1.84 to 6.22;P < 0.00001 ) . Logistic regression analysis identified shock , peripheral vascular disease , balloon angioplasty strategy , and unstable angina as independent predictors of in-hospital MACEs in the renal group . Compared with 362 age- and sex-matched patients selected from the control group , patients with renal failure had a lower survival rate ( 27.7 % versus 6.1 % , P < 0.0001 ) and a greater MACE rate ( 51 % versus 33 % , P < 0.001 ) at long-term follow-up . Cox regression analysis identified age and PTCA strategy as independent predictors of long-term MACEs in the renal group . Finally , within the renal failure population , the dialysis and nondialysis patients experienced remarkably similar immediate and long-term outcomes . Conclusions —Although patients with renal failure can be treated with a high procedural success rate in the new device era , they have an increased rate of major events both in hospital and at long-term follow-up . Nevertheless , utilization of stenting and debulking techniques improves immediate and long-term outcomes OBJECTIVES This study was design ed to evaluate the relationship between elevated creatinine levels and cardiovascular events . BACKGROUND End-stage renal disease is associated with high cardiovascular morbidity and mortality . The association of mild to moderate renal insufficiency with cardiovascular outcomes remains unclear . METHODS We analyzed data from the Cardiovascular Health Study , a prospect i ve population -based study of subjects , aged > 65 years , who had a serum creatinine measured at baseline ( n = 5,808 ) and were followed for a median of 7.3 years . Proportional hazards models were used to examine the association of creatinine to all-cause mortality and incident cardiovascular mortality and morbidity . Renal insufficiency was defined as a creatinine level > or = 1.5 mg/dl in men or > or = 1.3 mg/dl in women . RESULTS An elevated creatinine level  was present in 648 ( 11.2 % ) participants . Subjects with elevated creatinine had higher overall ( 76.7 vs. 29.5/1,000 years , p < 0.001 ) and cardiovascular ( 35.8 vs. 13.0/1,000 years , p < 0.001 ) mortality than those with normal creatinine levels . They were more likely to develop cardiovascular disease ( 54.0 vs. 31.8/1,000 years , p < 0.001 ) , stroke ( 21.1 vs. 11.9/1,000 years , p < 0.001 ) , congestive heart failure ( 38.7 vs. 17/1,000 years , p < 0.001 ) , and symptomatic peripheral vascular disease ( 10.6 vs. 3.5/1,000 years , p < 0.001 ) . After adjusting for cardiovascular risk factors and sub clinical disease measures , elevated creatinine remained a significant predictor of all-cause and cardiovascular mortality , total cardiovascular disease ( CVD ) , claudication , and congestive heart failure ( CHF ) . A linear increase in risk was observed with increasing creatinine . CONCLUSIONS Elevated creatinine levels are common in older adults and are associated with increased risk of mortality , CVD , and CHF . The increased risk is apparent early in renal disease Background — Clopidogrel is an inactive prodrug ; it is converted to its active metabolite through the cytochrome P450 ( CYP3A4 ) pathway , which also metabolizes calcium channel blockers ( CCBs ) . Several studies have reported that CCBs reduce the ability of clopidogrel to inhibit platelet aggregability ; one suggested that CCBs reduce the efficacy of clopidogrel . Methods and Results — We performed a post hoc analysis of the Clopidogrel for the Reduction of Events During Observation ( CREDO ) study to compare the treatment effect of clopidogrel in patients on CCBs versus not on CCBs . In CREDO , 2116 patients were r and omly assigned to 
    Output:
    
Patients with moderate RI have higher morbidity and mortality at 30 days and 1 year after PCI compared with patients with mild RI .
However , there is no difference in the incidence of TVR after PCI at 1 year between the 2 groups