injury (AKI) development. Many studies have demonstrated that worsening renal function due to contrast use is strongly associated with cardiovascular events. 7-9 It is also known that an under-expanding stent is associated with target vessel failure after PCI. 10,11 Thus, a high-quality imaging-guided PCI procedure with less contrast volume should improve the clinical outcomes of patients with CKD and ischemic heart disease. There is some evidence that mini-contrast PCI prevents renal events; 12-16 however, little data are available on the feasibility and safety of zerocontrast PCI for patients with CKD, 17,18 and the long-term I t is well known that patients with chronic kidney disease (CKD) have a high cardiovascular event rate. 1-4 The recent ISCHEMIA-CKD trial demonstrated that an initial invasive strategy did not improve the clinical outcomes in patients with moderate or severe ischemic heart disease and advanced CKD compared with an initial conservative strategy. 5 One explanation may be that most acute coronary syndrome cases occur as a consequence of plaque rupture in arteries without high-grade stenosis. Thus, prevention of acute coronary syndrome by prophylactic revascularization with percutaneous coronary intervention (PCI) is often difficult. 6 The more important cause may be contrast use during the PCI procedure. CKD is the strongest predictor of contrast-associated acute kidney Editorial p ????
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