title: Impact of chronic kidney disease on the efficacy of drug-eluting stents: long-term follow-up study.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) submitted to coronary angioplasty have higher rates of target lesion revascularization (TLR) and mortality. Drug-eluting stents (DES) are associated with a lower rate of restenosis, compared to bare metal stents (BMS), although data on DES efficacy and safety is limited in patients with CKD.
  
  
  OBJECTIVE
  We sought to evaluate the safety and efficacy of DES in patients with significant CKD as compared to patients without normal renal function in a real world registry.
  
  
  METHODS
  504 patients who underwent percutaneous coronary intervention with DES in two centers were included. Outcomes were stratified based on the presence of CKD, defined as a baseline glomerular filtration rate (GFR) < 60 ml/min/1.73 m².
  
  
  RESULTS
  The mean follow-up was 22.7 months. CKD was present in 165 patients (32.7%). Patients with CKD were older, had a higher incidence of hypertension and diabetes. CKD patients presented an increased incidence of death (12.3% vs 2.4%, p < 0.001) and myocardial infarction (MI) (7.4% vs 3.3%, p = 0.04) compared to patients without CKD. TLR rates were similar between groups (4.8% vs 5.6%, p = 0.7, CKD and no CKD patients, respectively). Independent predictors of death were CKD (HR 6.93; 2.4 - 19.5, p < 0.001), current smoking (HR 3.66; 1.20 - 11.10, p = 0.02) and diabetes (HR 2.66; 1.03 - 6.60, p = 0.045).
  
  
  CONCLUSIONS
  In this registry, coronary intervention with DES in patients with CKD was associated with similar TLR compared to patients without CKD, demonstrating the efficacy of DES in preventing in-stent restenosis in this patient population. CKD was related to significantly increased MI and mortality rates.
authors.affiliation: Hospital São Lucas da Pontifícia Universidade, Católica do Rio Grande do Sul, Brasil. vigomes@cardiol.br
authors.forename: Vitor
authors.initials: V
authors.lastname: Osório Gomes
authors.forename: Patrícia
authors.initials: P
authors.lastname: Blaya
authors.forename: Ricardo
authors.initials: R
authors.lastname: Lasevitch
authors.forename: Denise
authors.initials: D
authors.lastname: Oliveira
authors.forename: Patrícia
authors.initials: P
authors.lastname: Hickmann
authors.forename: Luís
authors.initials: L
authors.lastname: Smidt
authors.forename: Carisi
authors.initials: C
authors.lastname: Polanczyk
authors.forename: Paulo
authors.initials: P
authors.lastname: Caramori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012307:Risk Factors