Impact of drug-eluting stents on outcomes of patients with end-stage renal disease undergoing percutaneous coronary revascularization.
OBJECTIVE
End-stage renal disease (ESRD) patients on chronic dialysis are at heightened risk for target vessel revascularization (TVR) after coronary stenting. However, ESRD patients were excluded from the trials that demonstrated the superiority of drug-eluting stents (DES) over bare metal stents (BMS) in reducing TVR. We sought to identify the impact of stent type (DES versus BMS) on TVR and other cardiac adverse events in ESRD patients.


METHODS
The study included 89 consecutive ESRD patients who underwent coronary stenting and were followed for greater than or equal to 9 months. TVR was the primary endpoint, and the secondary endpoint was a composite of death, myocardial infarction (MI) and TVR. Multivariate logistic regression models were used to adjust for differences in clinical and procedural characteristics.


RESULTS
DES were used in 24 and BMS in 65 patients. The stent diameter was smaller (p = 0.008), but the stent length was longer (p = 0.006) in the DES group. TVR was required in 1 (4%) of DES and 17 (26%) BMS patients, while 8 (33%) DES and 39 (60%) BMS patients met the secondary endpoint. By multivariate logistic regression, DES use was associated with a significant reduction in TVR (OR 0.07, 95% CI 0.006-0.844; p = 0.036) and a significant reduction in death, MI and TVR (OR 0.11, 95% CI 0.022-0.513; p = 0.005).


CONCLUSIONS
A high rate of ischemic events was noted for ESRD patients, regardless of stent type. However, in ESRD patients undergoing coronary revascularization, DES use is effective in reducing 9-month TVR and the composite of death, MI and TVR.
Das
Pranab
P
Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the VA Medical Center, Lexington, Kentucky 40536-0200, USA.
Moliterno
David J
DJ
Charnigo
Richard
R
Mukherjee
Debabrata
D
Steinhubl
Steven R
SR
Sneed
J Darrell
JD
Booth
David C
DC
Ziada
Khaled M
KM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D009204:Myocardial Revascularization / Q000295:instrumentation / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome