Relationship between severity of renal impairment and 2-year outcomes after sirolimus-eluting stent implantation.
BACKGROUND
The presence of chronic kidney disease (CKD) is associated with an increased risk of restenosis and major adverse cardiac events (MACEs) after coronary interventions, especially in patients on hemodialysis (HD). The aim of this study was to assess the impact of varying degrees of renal impairment on angiographic and 2-year clinical outcomes after treatment with sirolimus-eluting stents (SESs).


METHODS
A total of 675 lesions of 593 patients treated with SES were analyzed. Patients were classified into 3 groups: 34 patients on HD; 337 patients with estimated glomerular filtration rate > or =60 mL min(-1) 1.73 m(-2) (non-CKD group); and 222 patients who had lower estimated glomerular filtration rate <60 mL min(-1) 1.73 m(-2) without HD dependency (CKD group).


RESULTS
At angiographic follow-up (201 +/- 73 days), in-segment late loss was markedly higher in the HD group versus the non-CKD and CKD groups (0.68 +/- 1.06 vs 0.11 +/- 0.45 and 0.15 +/- 0.50 mm, respectively, P < .001), resulting in a significantly higher in-segment restenosis rate (40.0% vs 10.4% and 11.5%, respectively, P < .001). At 2 years, HD vs non-CKD and CKD was associated with a significantly higher MACE rate (35.3% vs 10.4% and 12.6%, respectively, P < .001), mainly driven by significantly higher mortality (11.8% vs 0.6% and 2.3%, respectively, P < .001) and target-lesion revascularization (23.5% vs 9.2% and 8.1%, respectively, P = .016) rates. Multivariable analysis revealed that HD was the independent predictor of 2-year MACE (hazard ratio 4.70, 95% CI 2.40-9.20, P < .001).


CONCLUSIONS
Although angiographic and clinical outcomes after SES implantation were similarly favorable in non-HD-dependent CKD patients, regardless of renal function, in patients with end-stage CKD requiring HD, frequencies of restenosis and 2-year MACE were markedly higher than in non-HD-dependent patients.
Ota
Tomoyuki
T
Division of Cardiology, Toyota Memorial Hospital, 1-1 Heiwa-cho, Toyota, Japan.
Umeda
Hisashi
H
Yokota
Shigeki
S
Miyata
Shinjiro
S
Takamura
Atsushi
A
Sugino
Shigeo
S
Hayashi
Kazutaka
K
Ishiki
Ryoji
R
Takeichi
Yasushi
Y
Iwase
Mitsunori
M
Inagaki
Haruo
H
Murohara
Toyoaki
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death; D015897:Comorbidity; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology* / Q000401:mortality; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*
D020123:Sirolimus