Diminished benefits of drug-eluting stents versus bare metal stents in patients with severe renal insufficiency.
BACKGROUND
Since their introduction, the use of drug-eluting stents (DES) has increasingly become standard practice due to their decreased rates of in-stent restenosis and target lesion revascularization (TLR) rates in comparison to bare metal stents (BMS). However, these benefits have not been reproduced in patients with severe renal disease (SRD). This study compared TLR rates in patients with severe renal insufficiency treated with DES vs. BMS.


METHODS
Between 2003 and 2006, we collected data on 6,220 consecutive patients receiving either DES or BMS. Both groups were similar in angiographic and clinical variables. TLR rates at 270 days and 1 year were then compared between patients receiving DES or BMS with varying creatinine clearance (CrCl).


RESULTS
At 1 year after PCI, TLR rates were significantly lower for DES in patients with CrCl >60 (5 vs. 9.3%; p < 0.0001). However, in patients with CrCl <40 ml/min or on dialysis there was no significant difference in TLR rates for DES vs. BMS.


CONCLUSIONS
While DES showed improved clinical outcomes in patients with normal and mildly impaired renal function, they showed no benefit over BMS in patients with moderate to severe renal insufficiency. Coupled with the possibly increased risk of late stent thrombosis with DES, BMS may be a more appropriate and safer stent in this population.
Rosenblum
Michael A
MA
Department of Internal Medicine, The Mount Sinai Medical Center, New York, N.Y., USA. Rosenbma@musc.edu
Robbins
Michael J
MJ
Farkouh
Michael E
ME
Winston
Jonathan A
JA
Kim
Michael C
MC
D000368:Aged; D000369:Aged, 80 and over; D023903:Coronary Restenosis / Q000503:physiopathology / Q000517:prevention & control*; D016208:Databases, Factual; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
D008670:Metals