title: Association between drug-eluting stent type and clinical outcomes in patients with chronic kidney disease undergoing percutaneous coronary intervention.
abstract: BACKGROUND
  The comparative efficacy of first- vs second-generation drug-eluting stents (DESs) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) is unknown.
  
  
  METHODS
  A retrospective analysis of consecutive patients undergoing PCI at a tertiary PCI center from 2007-2011 was performed, with linkage to administrative databases for long-term outcomes. CKD was defined as creatinine clearance (CrCl) < 60 mL/min. Propensity matching by multivariable scoring method and Kaplan-Meier analyses were performed.
  
  
  RESULTS
  Of 6481 patients with available CrCl values undergoing a first PCI during the study period, 1658 (25%) had CKD. First- and second-generation DESs were implanted in 320 (19.3%) and 128 (7.7%) patients with CKD, respectively. At 2 years, no significant differences were observed between first-generation (n = 126) and second-generation (n = 126) propensity-matched DES cohorts for the outcomes of death (19% vs 16%; P = 0.51), repeat revascularization (10% vs 10%; P = 1.00), and major adverse cardiovascular and cerebrovascular events (MACCE) (36% vs 37%; P = 0.90). The 2-year Kaplan-Meier survival was also similar (P = 0.77). In patients with CKD, second-generation DES type was not an independent predictor for death (P = 0.49) or MACCE (P = 1.00).
  
  
  CONCLUSIONS
  Although the use of first- and second-generation DESs was associated with similar 2-year safety and efficacy in patients with CKD, our results cannot rule out a beneficial effect of second- vs first-generation DESs owing to small sample size. Future studies with larger numbers of patients with CKD are needed to identify optimal stent types, which may improve long-term clinical outcomes.
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Chan
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kotowycz
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sibbald
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Ross
authors.initials: R
authors.lastname: McGeoch
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Noel
authors.initials: N
authors.lastname: Crooks
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Rachael
authors.initials: R
authors.lastname: Hatton
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Douglas
authors.initials: D
authors.lastname: Ing
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Daly
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Mackie
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Osten
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Seidelin
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Barolet
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Overgaard
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: vlad.dzavik@uhn.ca.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
mesh_terms: D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies