title: Drug-Eluting Stents Versus Bare Metal Stents for Percutaneous Coronary Intervention in Kidney Transplant Recipients.
abstract: BACKGROUND
  The comparative effectiveness of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus bare metal stents (BMS) has not been studied in the kidney transplant population.
  
  
  METHODS
  Using the US Renal Data System, we identified 3245 kidney transplant patients who underwent PCI between April 2003 and December 2010; 2400 and 845 patients received DES and BMS, respectively. We used propensity score matching and inverse probability of treatment weighting to create DES- and BMS-treated groups whose observed baseline characteristics were well-balanced. The associations between stent type and the outcomes of (1) death; (2) death or myocardial infarction (MI); (3) death, MI, or repeat revascularization (RR); and (4) hospitalized bleeding were compared using Cox proportional hazards regression.
  
  
  RESULTS
  Drug-eluting stent use increased during the study period, mirroring the trend described in the general population. In the propensity score-matched cohort, no significant association among DES (vs BMS) use and outcomes was observed at 1 and 2 years of follow-up. However, at 3 years, DES was associated with 20% (95% confidence interval [CI], 4-33%) lower risk of death, 15% (95% CI, 1-27%) lower risk of death or MI, and 14% (95% CI, 2-24%) lower risk of death, MI, or repeat revascularization. There were no significant differences in rates of hospitalized bleeding at any time point. Results were similar in the inverse probability of treatment weighting analysis.
  
  
  CONCLUSIONS
  In this retrospective study of US kidney transplant recipients undergoing PCI, DES was associated with better clinical outcomes beyond 2 years of follow-up.
authors: 1 Division of Nephrology, Department of Medicine, Stanford School of Medicine, Palo Alto, CA. 2 Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
authors: Colin R
authors: CR
authors: Lenihan
authors: Maria E
authors: ME
authors: Montez-Rath
authors: Wolfgang C
authors: WC
authors: Winkelmayer
authors: Tara I
authors: TI
authors: Chang
mesh_terms: D000368:Aged; D057186:Comparative Effectiveness Research; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016208:Databases, Factual; D054855:Drug-Eluting Stents / Q000639:trends; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality / Q000639:trends; D057216:Propensity Score; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000639:trends; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D008670:Metals