Use of drug-eluting stents in patients with coronary artery disease and renal insufficiency.
Renal insufficiency (RI) has been shown to be associated with increased major adverse cardiovascular events after percutaneous coronary intervention. We reviewed the impact of RI on the pathogenesis of coronary artery disease and outcomes after percutaneous coronary intervention in the form of drug-eluting stent (DES) implantation in these high-risk patients. We searched the English-language literature indexed in MEDLINE, Scopus, and EBSCO Host research databases from 1990 through January 2009, using as search terms coronary revascularization, drug-eluting stent, and renal insufficiency. Studies that assessed DES implantation in patients with various degrees of RI were selected for review. Most of the available data were extracted from observational studies, and data from randomized trials formed the basis of a post hoc analysis. The outcomes after coronary revascularization were less favorable in patients with RI than in those with normal renal function. In patients with RI, DES implantation yielded better outcomes than did use of bare-metal stents. Randomized trials are needed to define optimal treatment of these high-risk patients with coronary artery disease.
El-Menyar
Ayman A
AA
Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital and Weill Cornell Medical College in Qatar, Doha, Qatar.
Al Suwaidi
Jassim
J
Holmes
David R
DR
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001791:Blood Platelet Disorders / Q000150:complications; D003287:Contrast Media / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology / Q000209:etiology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications* / Q000453:epidemiology; D012107:Research Design; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
D003287:Contrast Media