title: Comparison of sirolimus- and paclitaxel-eluting stents in patients with moderate renal insufficiency: results from the J-DESsERT trial.
abstract: BACKGROUND
  It is unclear whether there are differences in clinical outcomes between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with moderate renal insufficiency (RI).
  
  
  METHODS
  The Japan-Drug Eluting Stents Evaluation; a Randomized Trial (J-DESsERT) was a prospective, randomized multicenter trial which compared 1:1 coronary stenting between SES and PES patients. Patient with serious RI (serum creatinine value 2mg/dL or higher) were excluded. Patients were classified into 2 arms according to renal function: a non-RI arm of 2220 patients (SES 1094 and PES 1126 patients with estimated glomerular filtration rate (eGFR) ≥60 mL min(-1) 1.73 m(-2)) and an RI arm of 1206 patients (SES 613, PES 593 with 30≤eGFR <60 mL min(-1) 1.73 m(-2)).
  
  
  RESULTS
  At 12 months, the primary endpoint of target vessel failure in the non-RI arm occurred in 6.0% in the SES group and 8.7% in the PES group (p=0.02). In the RI arm, this occurred in 5.7% and 8.1% (p=0.10). Mortality rates were 0.8% vs 0.7% (p=0.78) in the non-RI arm, and 2.2% vs 2.1% (p=0.90) in the RI arm. Cardiac death was 0.4% vs 0.1% (p=0.17) in the non-RI arm, and 1.0% vs 1.0% (p=0.96) in the RI arm. Mortality was higher in patients with RI than those without RI (2.1% vs 0.8%; p<0.01). Cardiac death rates increased in the RI arm compared with those in the non-RI arm (1.0% vs 0.2%; p<0.01).
  
  
  CONCLUSIONS
  Regardless of the presence or absence of moderate RI, differences in outcomes between SES and PES change little except mortality and cardiac death.
authors.affiliation: Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan. Electronic address: Masaya.Otsuka@ma7.seikyou.ne.jp.
authors.forename: Masaya
authors.initials: M
authors.lastname: Otsuka
authors.affiliation: Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Yokoi
authors.affiliation: Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsuyama
authors.affiliation: Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shiode
authors.affiliation: Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Masaoka
authors.affiliation: Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Okimoto
authors.affiliation: Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Tamekiyo
authors.affiliation: Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Kawase
authors.affiliation: Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yamane
authors.affiliation: Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Kagawa
authors.affiliation: Department of Cardiovascular Medicine, Toho University School of Medicine, Ohashi Medical Center, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Nishinomiya Hospital Affairs, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nanto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D023903:Coronary Restenosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000628:therapy*; D018570:Risk Assessment; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel; D020123:Sirolimus
keywords: Japan-Drug Eluting Stents Evaluation: a Randomized Trial (J-DESsERT); Paclitaxel-eluting stents; Renal insufficiency; Sirolimus-eluting stents