Drug-eluting vs. bare-metal stents for treatment of acute myocardial infarction with renal insufficiency. Results from Korea Acute Myocardial Infarction Registry.
BACKGROUND
Patients with chronic kidney disease have had conflicting results between drug-eluting stents (DES) and bare-metal stents (BMS). The aim of the present study was to determine whether DES is preferable for the treatment of acute myocardial infarction (AMI) with renal insufficiency, and to elucidate the impact of diabetes mellitus (DM) on outcomes of each stent.


RESULTS
As a part of the Korea Acute Myocardial Infarction Registry (KAMIR), 2,175 AMI patients with renal insufficiency (glomerular filtration rate <60ml/min) comprising 208 patients with BMS and 1,967 DES implantation were selected. Primary outcome was major adverse cardiac event (MACE), defined as a composite of mortality, nonfatal myocardial infarction, and target lesion revascularization. In the overall population, the MACE rate at 1 year was significantly higher in the BMS group than that of DES (44% vs. 26%, P<0.05), which was mainly due to death rather than repeat intervention (44% vs. 26%, P<0.05). In the diabetic group with DES implantation, the MACE rate was higher compared with the DES group without DM, mainly due to repeat intervention (5% vs. 8%, P<0.05).


CONCLUSIONS
In AMI patients with renal insufficiency, DES implantation exhibits a favorable 1-year clinical outcome than BMS implantation, and subgroup analysis for diabetic subjects showed worse outcomes in the DM group with implanted DES.
Department of Internal Medicine, Chonnam National University Medical School, Korea.
Eun Hui
EH
Bae
Sang Yup
SY
Lim
Young Hwan
YH
Choi
Sang Heon
SH
Suh
Kyung Hoon
KH
Cho
Joon Seok
JS
Choi
Chang Seong
CS
Kim
Jeong Woo
JW
Park
Seong Kwon
SK
Ma
Myung Ho
MH
Jeong
Soo Wan
SW
Kim
D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D056910:Republic of Korea