Impact of chronic renal insufficiency on clinical outcomes in patients undergoing saphenous vein graft intervention with drug-eluting stents: a multicenter Southern Californian Registry.
OBJECTIVE
To evaluate the clinical outcomes in patients with chronic renal insufficiency (CRI) who undergo saphenous vein graft (SVG) intervention with drug-eluting stents (DES).


BACKGROUND
Patients with CRI have higher rates of major adverse cardiac events (MACE) after percutaneous revascularization. SVG intervention is associated with increased rates of MACE compared with percutaneous revascularization of native arteries. However, the impact of CRI on SVG intervention with DES has not been well delineated.


METHODS
Consecutive patients who underwent SVG intervention with DES at five medical centers from April 2003 to December 2007 were included in this analysis.


RESULTS
A total of 172 patients, 39 patients with CRI and a serum creatinine > or =1.5 mg dL(-1), and 133 patients without CRI, underwent SVG intervention with DES. Patients with CRI were more often older, diabetic, and had a longer mean total stent length. At 1 year, patients with CRI had a higher MACE rate (35.9% vs. 15.8%, hazard ratio [HR] 2.48, 95% confidence interval [CI] 1.26-4.88, log rank P = 0.009), mainly driven by higher mortality (20.5% vs. 9.8%, HR 3.41, 95% CI 1.10-10.58, log rank P = 0.024). There was a trend toward higher rates of target vessel revascularization in the CRI group (21.8% vs. 10.3%, HR 2.42, 95% CI 0.94-6.24, log rank P = 0.059). Stent thrombosis rates were not different between patients with and without CRI (2.6% vs. 2.3%, P = 0.8). Multivariable analysis revealed that CRI was the only significant predictor of 1-year MACE (HR 2.2, 95% CI 1.1-4.3; P = 0.03).


CONCLUSIONS
Patients with CRI who underwent SVG intervention with DES had higher risks of MACE and death compared with patients with preserved renal function. Further treatment strategies are needed in this high-risk group who undergo SVG intervention with DES.
Lee
Michael S
MS
Division of Cardiology, UCLA Medical Center, University of California-Los Angeles, 10833 LeConte Avenue, Los Angeles, CA, USA. mslee@mednet.uclaedu
Hu
Patrick P
PP
Aragon
Joseph
J
Shah
Atman
A
Bhatia
Ravi
R
Jones
Nathaniel
N
Penny
William
W
French
William
W
Tobis
Jonathan
J
Mahmud
Ehtisham
E
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002140:California; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D003404:Creatinine