[Limitation on efficacy of sirolimus-eluting stent implantation in patients on hemodialysis].
BACKGROUND
Patients receiving chronic hemodialysis develop complicated coronary lesions with tortuosity and calcification, which make stent delivery or expansion difficult. Restenosis rates are also higher than in patients without hemodialysis. Furthermore, there is a risk of polymer rubbing from the surface of a sirolimus-eluting stent(SES)placed across a calcified lesion. This study investigated the efficacy of SES for patients on hemodialysis compared with bare metal stent (BMS).


RESULTS
Forty-two patients on hemodialysis underwent percutaneous coronary intervention for 46 de novo lesions treated with SES (SES group). Seventy-four patients with 78 de novo lesions were treated with BMS (BMS group). The mean age was 65.8 +/- 9.3 yr in the SES group, and 65.0 +/- 8.7 yr in the BMS group. The mean hemodialysis period was significantly longer in the SES group (9.2 +/- 7.9 vs 6.5 +/- 7.7 yr, p < 0.01). Angiographic characteristics and acute results showed no significant difference between the two groups. At 6 months follow-up, late loss was significantly smaller in the SES group (0.60 +/- 0.97 vs 1.60 +/- 1.15 mm, p < 0.05). Binary restenosis and target lesion revascularization were similar (34% vs 43%, 25% vs 36%, respectively, p = NS). Major adverse cardiac events, composite of death, myocardial infarction, and target vessel revascularization were also similar (23% vs 36%, p = NS).


CONCLUSIONS
Our study could not demonstrate the superiority of SES implantation in patients with hemodialysis compared to BMS implantation, which suggests the limitations of using SES.
Suzuki
Kenji
K
Department of Cardiology, Sendai Kosei Hospital, Hirose-cho 4-15, Aoba-ku, Sendai 980-0873. k-y.suzuki@nifty.com
Inoue
Naoto
N
Matsuo
Akiko
A
Shiono
Yasutsugu
Y
Nakanishi
Naohiko
N
Otsuki
Yumi
Y
Nishibori
Yoshiharu
Y
Inoue
Keiji
K
Tanaka
Tetsuya
T
Fujita
Hiroshi
H
Kitamura
Makoto
M
Nishimura
Masato
M
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects
D020123:Sirolimus