Sirolimus-eluting stents versus paclitaxel-eluting stents in patients with chronic renal insufficiency.
BACKGROUND
Chronic renal insufficiency (CRI) is associated with an increased incidence of restenosis and stent thrombosis. Drug-eluting stents (DES), when compared to bare metal stents (BMS), reduce the incidence of restenosis in these patients. This study aimed to examine whether there are differences in clinical outcome after implantation of sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES) in patients with CRI who are subjected to coronary intervention.


METHODS
A cohort of 570 patients with CRI who underwent intervention with DES (346 with SES and 224 with PES) were followed clinically up to 1 year and the clinical events were recorded and compared between groups.


RESULTS
Baseline and procedural characteristics were similar, with a slightly higher number of diseased vessels in the SES group as compared to the PES group (2.3 +/- 0.9 vs 2.1 +/- 0.9, P = 0.06). The overall rates of major adverse cardiac events (MACE) and stent thrombosis were similar. The PES group had lower revascularization rates when compared to the SES group. After covariate adjustment, however, there was no difference seen in target vessel revascularization between stent types (hazard ratio [HR]: 2.3 [0.8-6.2], P = 0.110). The strongest predictor of death and MACE at 1 year was the number of diseased vessels.


CONCLUSIONS
Patients with CRI who undergo PCI with either SES or PES have similar repeat revascularization rates and acceptable stent thrombosis rates, although they continue to have high MACE and death rates.
Syed
Asmir I
AI
Division of Cardiology, Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA.
Ben-Dor
Itsik
I
Collins
Sara D
SD
Gonzalez
Manuel A
MA
Gaglia
Michael A
MA
Torguson
Rebecca
R
Satler
Lowell F
LF
Suddath
William O
WO
Pichard
Augusto D
AD
Lindsay
Joseph
J
Waksman
Ron
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D023903:Coronary Restenosis / Q000517:prevention & control*; D003328:Coronary Thrombosis / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000517:prevention & control; D017239:Paclitaxel / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States
D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus