Safety and efficacy of drug-eluting stents in older patients with chronic kidney disease: a report from the linked CathPCI Registry-CMS claims database.
OBJECTIVE
The purpose of this study was to determine the safety and efficacy of drug-eluting stents (DES) compared with bare-metal stents (BMS) in older patients with chronic kidney disease (CKD).


BACKGROUND
DES may be associated with late death and myocardial infarction (MI) secondary to stent thrombosis. However, data on outcomes in older patients with CKD are limited.


METHODS
We estimated the glomerular filtration rate (GFR) of 283,593 patients 65 years of age and older who underwent stent implantation between 2004 and 2007. In propensity-matched cohorts grouped by GFR, the association between DES and BMS and the risk of death, MI, revascularization, and major bleeding was examined.


RESULTS
A total of 121,446 patients (42.8%) had CKD (GFR <60 ml/min/1.73 m(2)). The 30-month mortality rate for patients on long-term dialysis was 52.0%. In propensity-matched pairs, placement of a DES compared with a BMS in patients with normal renal function was associated with significant reductions in 30-month revascularization (hazard ratio [HR]: 0.91; 95% confidence interval [CI]: 0.86 to 0.95), MI (HR: 0.77; 95% CI: 0.71 to 0.83), and death (HR: 0.73; 95% CI: 0.69 to 0.77), but no difference in bleeding (HR: 0.89; 95% CI: 0.79 to 1.00). Lower MI and mortality rates were also observed after DES compared with BMS implantation in all CKD subgroups with the exception of MI in the long-term dialysis group. Decreased rates of revascularization did not extend to any subgroup of patients with CKD.


CONCLUSIONS
The safety of DES compared with BMS is observed in all patients regardless of renal function and is associated with reduced rates of MI and death in some subsets of patients with CKD.
Denver VA Medical Center, Denver, Colorado 80220, USA. Thomas.Tsai@va.gov
Thomas T
TT
Tsai
John C
JC
Messenger
J Matthew
JM
Brennan
Uptal D
UD
Patel
David
D
Dai
Robert N
RN
Piana
Kevin J
KJ
Anstrom
Eric L
EL
Eisenstein
Rachel S
RS
Dokholyan
Eric D
ED
Peterson
Pamela S
PS
Douglas
D000368:Aged; D054855:Drug-Eluting Stents; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000628:therapy*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D016017:Odds Ratio; D057216:Propensity Score; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D012720:Severity of Illness Index; D015607:Stents; D014481:United States