title: Comparison of outcomes using the sirolimus-eluting stent in calcified versus non-calcified native coronary lesions in patients on- versus not on-chronic hemodialysis (from the j-Cypher registry).
abstract: The impact of lesion calcium on long-term outcomes after drug-eluting stent implantation has not been adequately addressed. In 10,595 patients (16,803 lesions) who were exclusively treated with sirolimus-eluting stents in the j-Cypher registry, 5-year outcomes were compared between patients with ≥1 lesion with moderate or severe calcification (the calcium group) and those with noncalcified lesions only (the noncalcium group). Analyses were stratified by hemodialysis (HD) status (non-HD stratum [calcium n = 3,191, noncalcium n = 6,824] and HD stratum [calcium n = 415, noncalcium n = 165]). Adjusted risk in the calcium group for death and target lesion revascularization was significant in the non-HD stratum (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.18 to 1.52, p <0.0001, and HR 1.2, 95% CI 1.07 to 1.36, p = 0.003) and the HD stratum (HR 1.4, 95% CI 1.06 to 1.86, p = 0.02, and HR 2.25, 95% CI 1.51 to 3.36, p <0.0001). Risk for definite stent thrombosis tended to be higher in the calcium group in the HD stratum (HR 5.05, 95% CI 0.66 to 38.9, p = 0.12) but not in then non-HD stratum (HR 1.16, 95% CI 0.81 to 1.67, p = 0.41). The use of rotational atherectomy in patients with severe calcification did not have a significant impact on the cumulative incidence of target lesion revascularization in the non-HD stratum (17.7% [n = 268] with vs 18.2% [n = 588] without rotational atherectomy, p = 0.68) and the HD stratum (54.7% [n = 115] with vs 51.9% [n = 118] without rotational atherectomy, p = 0.19). In conclusion, regardless of HD status, patients with calcified lesions have increased long-term risk for death and target lesion revascularization after sirolimus-eluting stent implantation.
authors.affiliation: Division of Cardiology, Chikamori Hospital, Kochi, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Nishida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kawai
authors.forename: Ichiro
authors.initials: I
authors.lastname: Miyano
authors.forename: Yoko
authors.initials: Y
authors.lastname: Nakaoka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Kaname
authors.forename: Shuichi
authors.initials: S
authors.lastname: Seki
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kubokawa
authors.forename: Masahiko
authors.initials: M
authors.lastname: Fukatani
authors.forename: Naohisa
authors.initials: N
authors.lastname: Hamashige
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000379:methods; D058226:Plaque, Atherosclerotic / Q000737:chemistry / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis; D020123:Sirolimus; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications*
chemical_list: D020123:Sirolimus