[Chronic renal failure is associated with worse outcome after implantation of sirolimus eluting stent].
OBJECTIVE
Chronic renal failure (CRF) is an emergent pathology in industrialized countries and is associated with high prevalence of coronary artery disease. Our aim is to determine the influence of CRF in the appearance of adverse cardiovascular events after sirolimus-eluting stent implantation in a non selected cohort.


METHODS
Observational retrospective study with a cohort of 461 patients who received one or more sirolimus-eluting stent between September 2002 and December 2005 at our institution. We evaluated the incidence of adverse cardiovascular events during the follow-up period and their relation with chronic kidney disease. We used the abbreviated Modification of Diet in Renal Disease (MDRD) equation to calculate the GFR.


RESULTS
The mean follow-up was 42 months (SD ± 13) and the mean age was 61 ± 11 years and 85 percent of the group were men. Chronic renal failure was present in 50 patients, 11 percent of the cohort. In a multivariate model, after adjustment for age, sex, left ventricle election fraction, anemia, diabetes, hypertension, Killip class and stent thrombosis, chronic renal failure was an independent predictive factor of death from any cause (hazard ratio, 3.82; 95 percent confidence interval, 1.41-10.33, p = 0.008), and an significant risk factor for restenosis (hazard ratio 3.47; 95 percent confidence interval, 1.01-11.97, p = 0.045). Significant differences were not found in thrombosis between patients with or without CRF (8% vs 3.4%, p = 0,109), although a trend was observed in the CRF group. There no were statistical association with need for a new target vessel revascularization (TVR) after coronary intervention either (18.8% versus 10.5%, p = 0.094).


CONCLUSIONS
The presence of chronic renal failure in patients with coronary disease is associated with higher risk of restenosis and is a potent predictor of mortality after sirolimus-eluting stent implantation.
López Otero
Diego
D
Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España. birihh@yahoo.es
Bastos Fernández
María
M
Alvarez Barredo
María
M
Trillo Nouche
Ramiro
R
Souto Castro
Pablo
P
Cid Alvarez
Belén
B
Dominguez Touriño
María E
ME
Gonzalez Juanatey
Jose R
JR
D000368:Aged; D017130:Angioplasty; D000925:Anticoagulants / Q000627:therapeutic use; D002423:Cause of Death; D015331:Cohort Studies; D003131:Combined Modality Therapy; D023903:Coronary Restenosis / Q000453:epidemiology; D023921:Coronary Stenosis / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D004343:Drug Implants; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects*; D019851:Thrombophilia / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome
D000925:Anticoagulants; D004343:Drug Implants; D020123:Sirolimus