title: Comparison of bare-metal and drug-eluting stents in patients with chronic kidney disease (from the NHLBI Dynamic Registry).
abstract: Patients with chronic kidney disease (CKD) have a disproportionate burden of coronary artery disease and commonly undergo revascularization. The role and safety of percutaneous coronary intervention (PCI) using drug-eluting stents (DESs) verses bare-metal stents in patients with CKD not on renal replacement therapy has not been fully evaluated. This study investigated the efficacy and safety of DES in patients with CKD not on renal replacement therapy. Patients were drawn from the National Heart, Lung, and Blood Institute Dynamic Registry and were stratified by renal function based on estimated glomerular filtration rate (GFR). Of the 4,157 participants, 1,108 had CKD ("low GFR" <60 ml/min/1.73 m(2)), whereas 3,049 patients had normal renal function ("normal GFR" ≥60 ml/min/1.73 m(2)). For each stratum of renal function we compared risk of death, myocardial infarction, or repeat revascularization between subjects who received DESs and bare-metal stents at the index procedure. Patients with low GFR had higher 1-year rates of death and myocardial infarction and a decreased rate of repeat revascularization compared to patients with normal GFR. Use of DESs was associated with a decreased need for repeat revascularization in the normal-GFR group (adjusted hazard ratio 0.63, 95% confidence interval 0.50 to 0.79, p <0.001) but not in the low-GFR group (hazard ratio 0.69, 95% confidence interval 0.45 to 1.06, p = 0.09). Risks of death and myocardial infarction were not different between the 2 stents in either patient population. In conclusion, presence of CKD predicted poor outcomes after PCI with high rates of mortality regardless of stent type. The effect of DES in decreasing repeat revascularization appeared to be attenuated in these patients.
authors: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pennsylvania, USA.
authors: Sandy M
authors: SM
authors: Green
authors: Faith
authors: F
authors: Selzer
authors: Suresh R
authors: SR
authors: Mulukutla
authors: Edward J
authors: EJ
authors: Tadajweski
authors: Jamie A
authors: JA
authors: Green
authors: Robert L
authors: RL
authors: Wilensky
authors: Warren K
authors: WK
authors: Laskey
authors: Howard A
authors: HA
authors: Cohen
authors: Sunil V
authors: SV
authors: Rao
authors: Steven D
authors: SD
authors: Weisbord
authors: Joon S
authors: JS
authors: Lee
authors: Steven E
authors: SE
authors: Reis
authors: Kevin E
authors: KE
authors: Kip
authors: Sheryl F
authors: SF
authors: Kelsey
authors: David O
authors: DO
authors: Williams
authors: Oscar C
authors: OC
authors: Marroquin
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011379:Prognosis; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology