title: Long-term benefits and risks of drug-eluting compared to bare-metal stents in patients with versus without chronic kidney disease.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) is associated with worse outcomes in patients with coronary artery disease (CAD). How CKD influences the benefit-risk balance of drug-eluting stents (DES) versus bare-metal stents (BMS) is less known.
  
  
  RESULTS
  In the multicentre BASKET-PROVE trial, 2314 patients in need of large coronary stenting (≥ 3.0mm) were randomised 2:1 to DES or BMS. In an a priori planned secondary analysis, outcomes were evaluated according to renal function defined by estimated glomerular filtration rates (eGFR; normal: eGFR ≥ 60 ml/min/1.73 m(2); CKD: eGFR<60 ml/min/1.73 m(2)). The primary endpoint was the first major adverse cardiac event (MACE: cardiac death, myocardial infarction, target vessel revascularisation) up to 2 years. A Cox proportional-hazard model was used to evaluate adjusted relative risks (hazard rates, HRs) for BMS versus DES. The interaction of stent type and renal function was tested. CKD patients (189 (11.2%)/1681 with such data) had a 2-year MACE rate of 8.5% versus 7.4% in those without CKD [HR 0.98 (0.56-1.72), p=0.95] with cardiac mortalities of 5.3% and 1.5%, respectively (p=0.002, non-significant after baseline adjustments). The MACE rate was lower in CKD patients with DES than with BMS [4.9% versus 15.2%, p=0.017, HR 0.29(0.10-0.80)] as was the MACE rate in patients without CKD [5.6% with DES versus 11.1% with BMS, p<0.0001, HR 0.51(0.35-0.75)]. No significant interaction between stent type and renal function was found.
  
  
  CONCLUSIONS
  This analysis of patients needing large coronary artery stenting confirms the increased mortality of CKD patients and documents a long-term benefit of DES compared to BMS irrespective of kidney function.
authors: Department of Cardiology, Innsbruck Medical University, Austria.
authors: Maria
authors: M
authors: Wanitschek
authors: Matthias
authors: M
authors: Pfisterer
authors: Anders
authors: A
authors: Hvelplund
authors: Stefano
authors: S
authors: De Servi
authors: Osmund
authors: O
authors: Bertel
authors: Raban
authors: R
authors: Jeger
authors: Peter
authors: P
authors: Rickenbacher
authors: Allan
authors: A
authors: Iversen
authors: Jan Skov
authors: JS
authors: Jensen
authors: Soeren
authors: S
authors: Galatius
authors: Christoph
authors: C
authors: Kaiser
authors: Hannes
authors: H
authors: Alber
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors
keywords: Bare metal stent; Chronic kidney disease; Coronary artery disease; Drug eluting stent; Large coronary artery stenting; MACE rates