Kidney dysfunction is a risk factor for interventional procedures in coronary artery disease. We analyzed this point. We studied 120 patients who had objective and angiographic evidence of myocardial ischemia and significant coronary artery disease (lesion > 70%) in two or more vessels. Forty patients underwent Percutaneous Coronary Intervention (PCI) of the significant lesions beside optimal medical therapy (PCI group II), 40 received optimal medical therapy alone (medical-therapy group III) and 40 were subjected to CABG (Group I). The choice between PCI and CABG was based on the Syntax score. The 40 pts on medical therapy alone either refused surgery (18), or were not suitable for surgery (12) or the lesions were not severe as assessed by FFR (7) or failed stenting (3). The primary outcome was death from any cause and nonfatal myocardial infarction during a follow-up period of 1 year. There was no significant difference between the three groups as regards incidence of diabetes, hypertension, dyslipidemia or age. Renal dysfunction (creatinine >2) was present in 18 pts (10+4+4). The highest was 2.28 mg/dl. Results comparing pts with creatinine >2 (18 pts) with those with creatinine < 2 (102 pts): Death 0 vs 4 (NS), non fatal MI 3 vs 8 (NS), heart failure 0 vs 10 (NS), recurrence of chest pain 3 vs 7 (NS). Conclusion: In 120 patients with multivessel disease treated by CABG or PCI or medical therapy, the presence of creatinine >2 and < 2.3 did 

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