PCI have a higher cardiovascular risk profile at baseline as well as more complex and advanced AG-013736 Coronary artery disease. Several previous reports have pointed to impaired clinical outcomes among patients with RI. Thus, RI has been associated with an increased risk of in-hospital and long-term adverse events in the balloon angioplasty era. Although the advent of bare metal stents improved procedural success rates, patients with RI remained at increased risk of death and MI as well as restenosis during long-term followup. DES have improved effectiveness by reducing the need for repeat revascularization and are used in the majority of patients undergoing PCI today. Notwithstanding, the impact of RI on clinical outcomes among patients undergoing DES implantation are limited to registry-based investigations, or to specific subsets of patients such as the elderly, patients with acute myocardial infarction, or patients with simple baseline clinical and angiographic characteristics. Against this background, we investigated the impact of RI on longterm clinical and angiographic outcomes in a patient-level pooled analysis of three large randomized trials with the unrestricted use of DES. Our study corroborates the findings of previous reports and indicates that the risk of cardiac death and MI is 2-fold increased among patients with moderate/severe RI. This risk reflects the higher complexity and baseline risk profile of patients with moderate/severe RI, and its persistence after adjustment for baseline differences highlights the independent negative impact of RI on patients’ prognosis. Coronary artery disease progression, myocardial structural changes with subsequent systolic and diastolic dysfunction, electrolyte imbalance, and autonomic dysfunction have been identified as major contributors of increased risk of cardiovascular adverse events in patients with RI. Of note, the risk of ST was unaffected by baseline renal function. Therefore, the increased risk of cardiac death or MI is not related to device-specific issues but rather to disease-specific changes in the individual patient risk profile. These findings suggest that patients with impaired renal function might benefit from a more intense medical therapy and a careful follow-up aiming at preventing coronary artery disease progression after percutaneous revascularization. Similarly, the risk of repeat revascularization as assessed by TLR and TVR did not differ between patients with moderate/severe RI, mild RI, and normal renal function suggesting that neointimal hyperplasia is potently suppressed by DES independent of baseline renal function. This observation is supported by the findings of quantitative coronary angiography during angiographic follow-up surveillance indicating a similar cumulative frequency of in-stent late loss in all three groups. In summary, these findings indicate that the DES effectiveness is not affected by renal function. This study has the following limitations. First, it is a pooled analysis from 3 randomized clinical trials not primarily intended to investigate differences in outcomes according to renal function at baseline. However, the large number of patients provides reasonable precision to evaluate differences.