Clinical and angiographic outcomes following percutaneous coronary intervention with sirolimus-eluting stents versus bare-metal stents in hemodialysis patients.
BACKGROUND
Percutaneous coronary intervention for hemodialysis patients has been hampered by the high rate of adverse cardiac events. Our aim was to investigate whether sirolimus-eluting stents (SESs) improve clinical outcomes of hemodialysis patients compared with bare-metal stents (BMSs).


METHODS
Retrospective study.


METHODS
123 consecutive patients on hemodialysis therapy treated with either an SES or BMS. There were 56 patients with 68 lesions treated with SESs between August 2004 and April 2006 (SES group) and 67 patients with 71 lesions treated with BMSs 4 years before approval of SESs in Japan (BMS group).


METHODS
SES and BMS implantation for hemodialysis patients with coronary artery disease.


METHODS
Follow-up angiography was performed at 6 to 8 months and clinical follow-up was obtained at 9 months after the procedure. Late lumen loss and major adverse cardiac events, including all-cause death, myocardial infarction, and target-lesion revascularization, were investigated.


RESULTS
Clinical follow-up was obtained in all patients. Angiographic follow-up was obtained in 50 patients (89.3%) in the SES group and 50 patients (74.6%) in the BMS group. The SES group had more complex lesions than the BMS group. Quantitative angiographic analysis showed a significant difference for in-stent late lumen loss (SES, 0.62 +/- 0.75 mm; BMS, 1.07 +/- 0.75 mm; P = 0.003). Of angiographic restenosis lesions analyzed, a focal restenotic pattern was observed more frequently in the SES group than the BMS group (SES, 87.5%; BMS, 23.8%; P < 0.001). The rate of major adverse cardiac events was significantly lower in the SES group (n = 14; 25.0%) than the BMS group (n = 26; 38.9%; log-rank P = 0.02).


CONCLUSIONS
Retrospective study design, small sample size, and a single-center study.


CONCLUSIONS
Clinical and angiographic data in the present study suggest that SESs are more effective than BMSs in hemodialysis patients.
Yachi
Sen
S
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Tanabe
Kengo
K
Tanimoto
Shuzou
S
Aoki
Jiro
J
Nakazawa
Gaku
G
Yamamoto
Hirosada
H
Otsuki
Shuji
S
Yagishita
Atsuhiko
A
Kishi
Satoru
S
Nakano
Masataka
M
Taniwaki
Masahiro
M
Sasaki
Shunsuke
S
Nakajima
Hiroyoshi
H
Mise
Naofumi
N
Sugimoto
Tokuichiro
T
Hara
Kazuhiro
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D006435:Renal Dialysis; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*
D020123:Sirolimus