title: Major adverse cardiac events in patients with moderate to severe renal insufficiency treated with first-generation drug-eluting stents.
abstract: No data are available comparing the long-term outcome of sirolimus-eluting stents (SESs) versus paclitaxel-eluting stents (PESs) in patients with moderate to severe renal insufficiency. The incidence of major adverse cardiac events (MACE), including death, myocardial infarction, and target vessel revascularization, during long-term follow-up were studied in patients with a glomerular filtration rate of <60 ml/min/1.73 m(2), as measured by the Modification of Diet in Renal Disease (MDRD) study equation, who also underwent percutaneous coronary intervention with drug-eluting stents. Of 428 patients studied, PESs were placed in 287 patients and SESs in 141 patients. Stepwise Cox regression analyses were performed to identify significant independent risk factors for MACE. At 47 + or - 19 months of follow-up, MACE had occurred in 49 (17%) of 287 patients in the PES group (mean age 71 + or - 11 years, 55% men) and in 31 (22%) of 141 patients in the SES group (mean age 71 + or - 12 years, 53% men). No significant difference was found in the MACE rate between the PES and SES groups. This persisted even after controlling for stent length, lesion complexity, and other co-morbidities. Also, all-cause mortality was not significantly different between the PES and SES groups (7.1% vs 8.5%, respectively). In conclusion, during long-term follow-up of patients with moderate to severe renal insufficiency, the rates of MACE and all-cause mortality were similar in the PES and SES groups.
authors.affiliation: Department of Medicine, Cardiology Division, New York Medical College, Valhalla, New York, USA. rishisukhija@yahoo.com
authors.forename: Rishi
authors.initials: R
authors.lastname: Sukhija
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.forename: Tarunjit
authors.initials: T
authors.lastname: Singh
authors.forename: Rashmi
authors.initials: R
authors.lastname: Sukhija
authors.forename: Kumar
authors.initials: K
authors.lastname: Kalapatapu
authors.forename: Diwakar
authors.initials: D
authors.lastname: Mohan
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Pucillo
authors.forename: Carmine
authors.initials: C
authors.lastname: Sorbera
authors.forename: Priyanka
authors.initials: P
authors.lastname: Kakar
authors.forename: Melvin B
authors.initials: MB
authors.lastname: Weiss
authors.forename: Purshotam
authors.initials: P
authors.lastname: Lal
authors.forename: Craig E
authors.initials: CE
authors.lastname: Monsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000628:therapy*; D003324:Coronary Artery Disease / Q000209:etiology / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D017239:Paclitaxel / Q000008:administration & dosage*; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*
chemical_list: D017239:Paclitaxel; D020123:Sirolimus