Moderate-Severe Renal Insufficiency Is a Risk Factor for Sirolimus-Eluting Stent Thrombosis

<i>Objective:</i> The RIFT study aimed to observe the impact of renal insufficiency (RI) on the incidence of stent thrombosis (ST) after percutaneous coronary intervention. <i>Methods:</i> The RIFT study enrolled 1,174 patients undergoing revascularization exclusively with sirolimus-eluting stents. The occurrence of ST and major adverse cardiac events were compared between patients with (n = 309) and without (n = 865) RI, and independent predictors of ST were also identified. <i>Results:</i> During follow-up (mean 18.9 ± 9.2 months), the rate of ST was significantly higher in patients with than without RI [5.5% (n = 17) vs. 1.7% (n = 15), p < 0.001], and the presence of severe RI (estimated glomerular filtration rate <30 ml/min·1.73 m²) was an independent predictor of ST (odds ratio = 4.5, 95% confidence interval 1.4–15, p = 0.011). In patients with RI and diabetes or left ventricular ejection fraction (LVEF) <50%, the incidence of ST was significantly increased [13.0% (n = 10) vs. 3.6% (n = 7), p = 0.010; 11.6% (n = 8) vs. 1.9% (n = 3), p = 0.004, respectively] compared to those with diabetes or LVEF <50% alone. The influence of RI on ST was not significant in patients with multivessel disease, calcified or bifurcation lesions, and target lesion revascularization. <i>Conclusions:</i> These findings substantiate the importance of long-term antiplatelet therapy for patients with RI after drug-eluting stent implantation.