title: [Limitation on efficacy of sirolimus-eluting stent implantation in patients on hemodialysis].
abstract: 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.
authors.affiliation: Department of Cardiology, Sendai Kosei Hospital, Hirose-cho 4-15, Aoba-ku, Sendai 980-0873. k-y.suzuki@nifty.com
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Naoto
authors.initials: N
authors.lastname: Inoue
authors.forename: Akiko
authors.initials: A
authors.lastname: Matsuo
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Shiono
authors.forename: Naohiko
authors.initials: N
authors.lastname: Nakanishi
authors.forename: Yumi
authors.initials: Y
authors.lastname: Otsuki
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Nishibori
authors.forename: Keiji
authors.initials: K
authors.lastname: Inoue
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujita
authors.forename: Makoto
authors.initials: M
authors.lastname: Kitamura
authors.forename: Masato
authors.initials: M
authors.lastname: Nishimura
mesh_terms: 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
chemical_list: D020123:Sirolimus