Clinical outcomes after percutaneous coronary intervention with drug-eluting stents in dialysis patients.
OBJECTIVE
We aimed to compare the clinical outcomes of dialysis versus nondialysis patients after coronary drug-eluting stent (DES) implantation.


BACKGROUND
The revascularization of ischemic heart disease in dialysis patients has remained controversial due to consistent exclusion of this population from major trials, especially in the context of percutaneous coronary interventions (PCI) with DES.


METHODS
We analyzed the data on 3,442 consecutive patients who underwent PCI and DES implantation since March 2003. Periprocedural events, 1- and 6-month clinical outcomes were then compared between dialysis (n = 72) and nondialysis patients (n = 3,370).


RESULTS
Baseline characteristics revealed a higher prevalence of female gender (p = 0.03), African Americans (p < 0.001), hypertension (p < 0.001), diabetes mellitus (p < 0.001), number of diseased vessels (p = 0.04), lower ejection fraction (p < 0.001), and a higher prevalence of acute myocardial infarction (MI) (p = 0.04) in dialysis patients. Nondialysis patients showed more history of smoking (p < 0.001) and obesity (p = 0.02). Procedural success was higher (p = 0.05), while there was a trend toward a lower mortality rate, in the nondialysis group during hospitalization. At 6 months, the restenosis rate was low and comparable, but mortality occurred more often (16% vs. 3.8%; p < 0.001) in dialysis patients. Multivariate analysis revealed cardiogenic shock (p = 0.04) to be an independent predictor of mortality.


CONCLUSIONS
PCI with DES in dialysis patients is safe and feasible, with a similar reduction of repeat revascularization when compared with nondialysis patients. There was, however, a higher incidence of mortality in dialysis patients at 6 months, mostly influenced by contributing comorbidities and more severe conditions at presentation.
Hassani
Salah-Eddine
SE
Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
Chu
William W
WW
Wolfram
Roswitha M
RM
Kuchulakanti
Pramod K
PK
Xue
Zhenyi
Z
Gevorkian
Natalie
N
Suddath
William O
WO
Satler
Lowell F
LF
Kent
Kenneth M
KM
Pichard
Augusto D
AD
Weissman
Neil J
NJ
Waksman
Ron
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome