title: The impact of new generation drug-eluting stent implantation on patients with chronic kidney disease and a single lesion in the proximal segment of the left anterior descending artery.
abstract: BACKGROUND
  The impact of drug-eluting stents (DES) has not been extensively investigated in patients with moderate to severe renal dysfunction, as these patients are consistently excluded from randomised studies. We sought to assess prospectively the effectiveness and safety of the new-generation DES in patients with moderate chronic kidney disease (CKD) and an isolated de novo lesion in the proximal segment of the left anterior descending artery (pLAD).
  
  
  METHODS
  We evaluated 400 consecutive patients with a pLAD lesion. There were 96 patients with moderate CKD (estimated glomerular filtration rate 59 ml/min/1.73 m2) and 304 without CKD. Major adverse cardiac events (MACE) were defined as death, non-fatal myocardial infarction and target lesion revascularisation (TLR). Clinical or telephone follow up was performed.
  
  
  RESULTS
  There was a significantly higher incidence of mortality in patients with CKD (n=4) as compared with non-CKD (n=2) (4.16% versus 0.65%, respectively, p=0.03). The rate of non-fatal myocardial infarction was similar in the 2 cohorts (p=0.59), as was the TLR rate (p=0.99). Overall, there were no significant differences regarding MACE between the 2 groups of patients (p=0.19) during the 13.62 ± 6.22 month follow-up period. The rate of angiographic stent thrombosis was 2.08% in the CKD group versus 0.98% in the non-CKD group (p=0.59).
  
  
  CONCLUSIONS
  New generation DES implantation in patients with CKD and a pLAD lesion is effective and safe, with rates of TLR and stent thrombosis comparable to those in patients with normal renal function. However, the higher mortality in patients with CKD needs further evaluation.
authors.affiliation: First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece. ktoutouz@otenet.gr
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Toutouzas
authors.forename: Chrysoula
authors.initials: C
authors.lastname: Patsa
authors.forename: Andreas
authors.initials: A
authors.lastname: Synetos
authors.forename: Antonis
authors.initials: A
authors.lastname: Karanasos
authors.forename: John
authors.initials: J
authors.lastname: Karampelas
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Tsiamis
authors.forename: Anastasios
authors.initials: A
authors.lastname: Spanos
authors.forename: Elli
authors.initials: E
authors.lastname: Stefanadi
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tousoulis
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D023921:Coronary Stenosis / Q000150:complications* / Q000628:therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; C489443:zotarolimus; D020123:Sirolimus