Comparison of drug-eluting versus bare-metal stent implantation in ST-elevation myocardial infarction patients with renal insufficiency: results from the national registry in Korea.
BACKGROUND
It is unknown whether drug-eluting stents (DES), in comparison with bare-metal stents (BMS), improve clinical outcomes of ST-elevation myocardial infarction (STEMI) patients with renal insufficiency. We aimed to compare the clinical outcomes of BMS versus DES, as well as sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES), in STEMI patients with renal insufficiency.


METHODS
From the Korea Acute Myocardial Infarction Registry, 874 STEMI patients with renal insufficiency (glomerular filtration rate < 60 ml/min) comprising 116 patients with BMS and 758 patients with DES (430 SES and 328 PES) implantation were selected. Major adverse cardiac events (MACE) within 1 year, defined as composite of all-cause mortality, nonfatal myocardial infarction and target lesion revascularization were compared. In addition to multivariate adjusted analysis, propensity analysis for stent choice was performed.


RESULTS
With a median follow-up of 342 days, 116 MACE occurred. MACE was more frequent in the BMS group than in the DES group before (HR [95% CI]=2.3 [1.3-3.8]) and after propensity score matching (HR [95% CI]=2.0 [1.0-3.8]). The difference of MACE was mainly driven by a higher rate of target lesion revascularization rate in the BMS group. In comparison between SES and PES, there was no significant difference between the 2 groups in propensity score-matched populations (HR [95% CI]=0.7 [0.4-1.1]).


CONCLUSIONS
In STEMI patients with renal insufficiency, DES implantation exhibits a favorable 1 year clinical outcomes than BMS implantation, however, no difference was found between SES and PES.
Kim
Kyung-Hee
KH
Department of Internal Medicine, Seoul National University Hospital, Republic of Korea.
Koo
Bon-Kwon
BK
Min
Hee-Suk
HS
Park
Sue K
SK
Kim
Chi-Hoon
CH
Park
Kyung-Woo
KW
Park
Byung-Joo
BJ
Jeong
Myung-Ho
MH
Cho
Myeong-Chan
MC
Lee
Sang-Rok
SR
Chae
Sung-Chull
SC
Seong
In-Whan
IW
Choi
Dong-Ju
DJ
Kim
Hyo-Soo
HS
D000368:Aged; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D051437:Renal Insufficiency / Q000150:complications; D056910:Republic of Korea; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents; D016896:Treatment Outcome
D017239:Paclitaxel; D020123:Sirolimus