***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 
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    Input: Background — Percutaneous coronary interventions in patients with chronic kidney disease have shown suboptimal results . Drug-eluting stents ( DES ) might reduce the rate of target vessel revascularization in comparison with bare-metal stents ( BMS ) in patients with chronic kidney disease . However , given the multiple concomitant individual variables present in such patients , the comparison of neointimal growth after percutaneous coronary intervention is complex and difficult to assess . Methods and Results — R and omized Comparison of Xience V and Multi-Link Vision Coronary Stents in the Same Multivessel Patient with Chronic Kidney Disease ( RENAL-DES ) was a prospect i ve , r and omized , multicenter study to directly compare the efficacy in the prevention of clinical restenosis of everolimus-eluting stent ( Xience V ) and BMS with an identical design ( Multi-Link Vision ) , both implanted in the same patient with multivessel coronary artery disease and chronic kidney disease ( estimated glomerular filtration rate < 60 mL/min ) . The primary end point of the study was the ischemia-driven target vessel revascularization as detected with myocardial scintigraphy at 12 months . In 215 patients , 512 coronary vessels were successfully treated with the r and omly assigned DES ( n=257 ) or BMS ( n=255 ) . At 1 year , the rate of ischemia-driven target vessel revascularization for DES and BMS groups was 2.7 % ( 95 % confidence interval , 1.1%–5.6 % ) and 11.4 % ( 95 % confidence interval , 7.8 % to 16 % ) , respectively , P<0.001 . For the multivariate analysis , independent predictors of the ischemia-driven target vessel revascularization were BMS implantation ( odds ratio , 4.95 ; 95 % confidence interval , 2.1–11.6 ; P<0.001 ) and vessel size ( odds ratio , 0.32 ; 95 % confidence interval , 0.1–0.7 ; P=0.006 ) . Conclusions — This is the first r and omized trial showing a reduction of clinical restenosis with a new-generation DES in comparison with a BMS of equal design , in patients who have chronic kidney disease with multivessel coronary artery disease . Clinical Trial Registration — URL : http:// clinical trials.gov . Unique identifier : NCT00818792 Background Chronic kidney disease ( CKD ) is strongly associated with adverse outcomes after percutaneous coronary intervention ( PCI ) . There are limited data on the effectiveness of drug-eluting stents ( DES ) in patients with CKD . Methodology /Principal Findings Of 3,752 consecutive patients enrolled in the Guthrie PCI Registry between 2001 and 2006 , 436 patients with CKD - defined as a creatinine clearance < 60 mL/min - were included in this study . Patients who received DES were compared to those who received bare metal stents ( BMS ) . Patients were followed for a mean duration of 3 years after the index PCI to determine the prognostic impact of stent type . Study end-points were all-cause death , myocardial infa rct ion ( MI ) , target vessel revascularization ( TVR ) , stent thrombosis ( ST ) and the composite of major adverse cardiovascular events ( MACE ) , defined as death , MI or TVR . Patients receiving DES in our study , by virtue of physician selection , had more stable coronary artery disease and had lower baseline risk of thrombotic or restenotic events . Kaplan-Meier estimates of proportions of patients reaching the end-points were significantly lower for DES vs. BMS for all-cause death ( p = 0.0008 ) , TVR ( p = 0.029 ) and MACE ( p = 0.0015 ) , but not MI ( p = 0.945 ) or ST ( p = 0.88 ) . Multivariable analysis with propensity adjustment demonstrated that DES implantation was an independent predictor of lower rates of all-cause death ( hazard ratio [ HR ] 0.48 , 95 % confidence interval [ CI ] 0.25–0.92 ) , TVR ( HR 0.50 , 95 % CI 0.27–0.94 ) and MACE ( HR 0.62 , 95 % CI 0.41–0.94 ) . Conclusions In a contemporary PCI registry , selective use of DES in patients with CKD was safe and effective in the long term , with lower risk of all-cause death , TVR and MACE and similar risk of MI and ST as compared with BMS . The mortality benefit may be a result of selection bias and residual confounding , or represent a true finding ; a hypothesis that warrants clarification by r and omized clinical trials Background —An observational study determining the long-term impact of  chronic kidney disease ( CKD )  on patients undergoing percutaneous coronary intervention at a tertiary cardiac referral center . CKD is associated with poor in-hospital outcomes after percutaneous coronary intervention , but its effect beyond 1 year , particularly in the drug-eluting stent ( DES ) era , has not been reported . Methods and Results —Baseline creatinine was available for 11 953 patients entered into a prospect i ve registry ( April 2000 to September 2007 ) . Patients were stratified : those with or without at least moderate CKD ( creatinine clearance , < 60 mL/min ) . Follow-up data were obtained through linkage to a provincial registry . Kaplan – Meier analysis was performed . Cox multiple-regression analysis identified independent predictors of late mortality and major adverse cardiac events ( MACE ) and examined the association between DES use and late outcomes in the presence or absence of CKD . CKD was present in 3070 patients ( 25.7 % ) . In-hospital mortality and MACE were significantly increased in CKD ( 3.34 % versus 0.44 % , P<0.001 and 5.73 % versus 2.2 % , P<0.001 ) . Survival and MACE-free survival at 7 years were reduced ( 64.5±1.4 % versus 89.4±0.5 % , P<0.001 ; 44.0±1.4 % versus 63.4±0.8 % , P<0.001 ) . CKD was an independent predictor of late mortality and MACE ( hazard ratio [ HR ] : 2.18 , CI : 1.90 to 2.49 , P<0.0001 ; HR : 1.37 , CI : 1.25 to 1.49 , P<0.0001 ) . DES use was associated with a significant reduction in both ( HR : 0.71 , CI : 0.60 to 0.83 , P<0.0001 ; HR : 0.70 , CI : 0.63 to 0.78 , P<0.0001 ) . In patients with CKD , DES use was associated with reduced revascularization ( HR : 0.68 , CI : 0.53 to 0.88 , P=0.004 ) and reduced MACE ( HR : 0.81 , CI : 0.69 to 0.95 , P=0.011 ) but not reduced mortality ( HR : 0.85 , CI : 0.69 to 1.05 , P=0.1 ) . Conclusion —In a large registry of “ all comers ” for percutaneous coronary intervention , CKD was an independent predictor of adverse late outcomes . DES use may be associated with improved long-term outcomes in this high-risk cohort , but further prospect i ve studies are required BACKGROUND Linkage to the US Renal Data System ( USRDS ) registry commonly is used to identify end-stage renal disease ( ESRD ) cases , or kidney failure treated with dialysis or transplantation , but it underestimates the total burden of kidney failure . This study vali date s a kidney failure definition that includes both kidney failure treated and not treated by dialysis or transplantation . It compares kidney failure risk factors and outcomes using this broader definition with USRDS-identified ESRD risk factors and outcomes . STUDY DESIGN Diagnostic test study with stratified r and om sampling of hospitalizations for chart review . SETTING & PARTICIPANTS Atherosclerosis Risk in Communities Study ( n=11,530 ; chart review , n=546 ) . INDEX TEST USRDS-identified ESRD ; treated or untreated kidney failure defined by USRDS-identified ESRD or International Classification of Diseases , Ninth or Tenth Revision , Clinical Modification ( ICD-9-CM/ICD-10-CM ) code for hospitalization or death . REFERENCE TEST For ESRD , determination of permanent dialysis therapy or transplantation ; for kidney failure , determination of permanent dialysis therapy , transplantation , or estimated glomerular filtration rate < 15 mL/min/1.73 m(2 ) . RESULTS During 13 years ' median follow-up , 508 kidney failure cases were identified , including 173 ( 34.1 % ) from the USRDS registry .  ESRD and kidney failure incidence were 1.23 and 3.66 cases per 1,000 person-years in the overall population and 1.35 and 6.59 cases per 1,000 person-years among participants older than 70 years , respectively . Other risk-factor associations were similar between ESRD and kidney failure , except diabetes and albuminuria , which were stronger for ESRD . Survivals at 1 and 5 years were 74.0 % and 24.0 % for ESRD and 59.8 % and 31.6 % for kidney failure , respectively . Sensitivity and specificity were 88.0 % and 97.3 % comparing the kidney failure ICD-9-CM/ICD-10-CM code algorithm to chart review ; for USRDS-identified ESRD , sensitivity and specificity were 94.9 % and 100.0 % . LIMITATIONS Some medical charts were incomplete . CONCLUSIONS A kidney failure definition including treated and untreated disease identifies more cases than linkage to the USRDS registry alone , particularly among older adults . Future studies might consider reporting both USRDS-identified ESRD and a more inclusive kidney failure definition AIMS Evaluation of the long-term safety and efficacy of second-generation everolimus-eluting stents ( EES ) versus first-generation sirolimus-eluting stents ( SES ) in acute myocardial infa rct ion ( AMI ) patients . METHODS AND RESULTS Six hundred and twenty-five patients were r and omised ( 2:1 ) to EES or SES in the multicentre XAMI ( XienceV stent vs. Cypher stent in Primary PCI for Acute Myocardial Infa rct ion ) trial . The primary endpoint was cardiac death , non-fatal AMI or any target vessel revascularisation ( TVR ) at one year , with a planned follow-up of three years . At three-year follow-up , the primary endpoint was 8.0 % for EES and 10.5 % for SES ( p=0.30 ) . Cardiac death was low and comparable in both groups ( EES : 2.5 % versus SES : 2.7 % ; p=0.86 ) , as was definite/probable stent thrombosis ( EES : 2.3 % versus SES 3.2 % ; p=0.60 ) . CONCLUSIONS The event rate at three years in this all-comer , r and omised , multicentre AMI trial was low , including stent thrombosis , with no significant difference between first- and second-generation DES . Registration of trial : http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=1123 C and i date number : 2869 ; NTR number : NTR1123 BACKGROUND Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications , yet the benefits and risks of treatment beyond 1 year are uncertain . METHODS Patients were enrolled after they had undergone a coronary stent procedure in which a drug-eluting stent was placed . After 12 months of treatment with a thienopyridine drug ( clopidogrel or prasugrel ) and aspirin , patients were r and omly assigned to continue receiving thienopyridine treatment or to receive placebo for another 18 months ; all patients continued receiving aspirin . The co primary efficacy end points were stent thrombosis and major adverse cardiovascular and cerebrovascular events ( a composite of death , myocardial infa rct ion , or stroke ) during the period from 12 to 30 months . The primary safety end point was moderate or severe bleeding . RESULTS A total of 9961 patients were r and omly assigned to continue thienopyridine treatment or to receive placebo . Continued treatment with thienopyridine , as compared with placebo , reduced the rates of stent thrombosis ( 0.4 % vs. 1.4 % ; hazard ratio , 0.29 [ 95 % confidence interval { CI } , 0.17 to 0.48 ] ; P<0.001 ) and major adverse cardiovascular and cerebrovascular events ( 4.3 % vs. 5.9 % ; hazard ratio , 0.71 [ 95 % CI , 0.59 to 0.85 ] ; P<0.001 ) . The rate of myocardial inf 
    Output:
    
The use of DESs significantly improves the above outcomes in CKD patients .