title: Long-term clinical outcomes following drug-eluting or bare-metal stent placement in patients with severely reduced GFR: Results of the Massachusetts Data Analysis Center (Mass-DAC) State Registry.
abstract: BACKGROUND
  Patients with chronic kidney disease have been under-represented in randomized trials of drug-eluting stents relative to bare-metal stents and are at high risk of mortality.
  
  
  METHODS
  Cohort study with propensity score matching.
  
  
  METHODS
  All adults with chronic kidney disease and severely decreased glomerular filtration rate (GFR; serum creatinine >2.0 mg/dL or dialysis dependence) undergoing percutaneous coronary intervention with stent placement between April 1, 2003, and September 30, 2005, at all acute-care nonfederal hospitals in Massachusetts.
  
  
  METHODS
  Patients were classified as drug-eluting stent-treated if all stents were drug eluting and bare-metal stent-treated if all stents were bare metal. Patients treated with both types of stents were excluded from the primary analysis.
  
  
  METHODS
  2-year crude mortality risk differences (drug-eluting - bare-metal stents) were determined from vital statistics records, and risk-adjusted mortality, myocardial infraction (MI), and revascularization differences were estimated using propensity score matching of patients with severely reduced GFR based on clinical and procedural information collected at the index admission.
  
  
  RESULTS
  1,749 patients with severely reduced GFR (24% dialysis dependent) were treated with drug-eluting (n = 1,256) or bare-metal stents (n = 493) during the study. Overall 2-year mortality was 32.8% (unadjusted drug-eluting stent vs bare-metal stent; 30.1% vs 39.8%; P < 0.001). After propensity score matching 431 patients with a drug-eluting stent to 431 patients with a bare-metal stent, 2-year risk-adjusted mortality, MI, and target-vessel revascularization rates were 39.4% versus 37.4% (risk difference, 2.1%; 95% CI, -4.3 to 8.5; P = 0.5), 16.0% versus 19.0% (risk difference, -3.0%; 95% CI, -8.2 to 2.1; P = 0.3), and 13.0% versus 17.6% (risk difference, -4.6%; 95% CI, -9.5 to 0.3; P = 0.06).
  
  
  CONCLUSIONS
  Observational design, ascertainment of serum creatinine level >2.0 mg/dL and dialysis dependence from case report forms.
  
  
  CONCLUSIONS
  In patients with severely decreased GFR, treatment with drug-eluting stents was associated with a modest decrease in target-vessel revascularization not reaching statistical significance and was not associated with a difference in risk-adjusted rates of mortality or MI at 2 years compared with bare-metal stents.
authors.affiliation: Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Charytan
authors.forename: Manu R
authors.initials: MR
authors.lastname: Varma
authors.forename: Treacy S
authors.initials: TS
authors.lastname: Silbaugh
authors.forename: Ann F
authors.initials: AF
authors.lastname: Lovett
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Laura
authors.initials: L
authors.lastname: Mauri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008404:Massachusetts; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D012042:Registries; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals