Clinical outcomes following percutaneous coronary intervention with drug-eluting vs. bare-metal stents in dialysis patients.
BACKGROUND
Late mortality among dialysis patients undergoing PCI with bare-metal stents is high. The impact of drug-eluting stent use on outcomes in such patients is unclear.


OBJECTIVE
To compare the clinical outcomes of dialysis patients undergoing coronary stenting with versus without the use of drug-eluting stents.


METHODS
Baseline features and outcomes were compared in dialysis patients undergoing coronary stent implantation using either bare-metal devices only (n = 41) or drug-eluting stents (n = 33), in recruitment waves 3 (2001-2002; n = 2,047) and 4 (2004; n = 2,112) of the National Heart Lung, and Blood Institute Dynamic Registry. The primary study endpoint was the composite of major adverse cardiac events (MACE), defined as death, myocardial infarction (MI) or any repeat revascularization procedure at 1-year follow up.


RESULTS
Baseline and procedural features and in-hospital MACE rates were similar in both groups. Cumulative 1-year rates of the composite MACE endpoint and all-cause mortality were lower in patients treated with drug-eluting versus bare-metal stents (25.2% vs. 57.3%; p = 0.01, and 18.4% and 36.8%, respectively; p = 0.09). By multivariable analysis, drug-eluting versus bare-metal stent use was independently associated with freedom from the composite MACE endpoint (hazard ratio = 0.24, 95% CI [0.10-0.60]; p = 0.002) and with a trend to lower all-cause mortality (HR = 0.40 [0.15-1.05]; p = 0.06) at 1 year.


CONCLUSIONS
In this cohort of dialysis patients undergoing percutaneous coronary intervention (PCI), drug-eluting versus bare-metal stent implantation was associated with enhanced freedom from 1-year MACE. Given previous bare-metal stent data indicating worse outcomes after PCI than after bypass surgery in dialysis patients, randomized trials comparing these strategies in the drug-eluting stent era are needed.
Halkin
Amir
A
Interventional Cardiology Department, Lenox Hill Hospital, New York, NY 10021, USA. ahalkin@netvision.net.il
Selzer
Faith
F
Marroquin
Oscar
O
Laskey
Warren
W
Detre
Katherine
K
Cohen
Howard
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D023903:Coronary Restenosis / Q000401:mortality; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis; D012307:Risk Factors; D015607:Stents / Q000592:standards / Q000706:statistics & numerical data*; D016019:Survival Analysis; D016896:Treatment Outcome
D007166:Immunosuppressive Agents