Sirolimus-eluting stent is superior to paclitaxel-eluting stent for coronary intervention in patients with renal insufficiency: Long-term clinical outcomes.
BACKGROUND
Renal insufficiency (RI) is an independent risk factor for the adverse cardiovascular events. Long-term clinical outcome of percutaneous coronary intervention (PCI) in patients with RI is unknown especially in the era of first generation drug-eluting stents (DES). This study aims at comparing clinical outcomes between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) based on large scaled registry.


METHODS
Patients who underwent PCI with DES from January 2004 to December 2009 in the Catholic University of Korea-PCI (COACT) registry were prospectively enrolled. A group of 1,033 patients with RI, defined as estimated glomerular filtration rate under 60 mL/min, were analyzed. Major adverse cardiac events (MACE), including all-cause death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR) according to the type of stents were compared.


RESULTS
Median follow-up period was 810 days (interquartile range: from 361 to 1,354 days). A group of 612 (59.2%) patients were treated with SES and 421 (40.8%) patients were treated with PES. The PES vs. SES group had significantly higher rate of MACE (35.9% vs. 28.3%, p = 0.01). In multivariate Cox hazard regression analysis, PES vs. SES group had significantly higher rate of MACE (adjusted hazard ratio [AHR] 1.29, 95% confidence interval [CI] 1.02-1.64, p = 0.033), particularly pronounced by all-cause death (AHR 1.34, 95% CI 1.008-1.770; p = 0.044). In further analysis with propensity score matching, overall findings were consistent.


CONCLUSIONS
In patients with RI, PCI using PES provides poorer clinical outcomes than SES in terms of MACE and all-cause death.
Soe Hee
SH
Ann
Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea. ssm530@catholic.ac.kr.
Suk Min
SM
Seo
Pum-Joon
PJ
Kim
Yoon-Seok
YS
Koh
Sung-Ho
SH
Her
Dong Il
DI
Shin
Hun-Jun
HJ
Park
Chul Soo
CS
Park
Jong Min
JM
Lee
Dong-Bin
DB
Kim
Kiyuk
K
Chang
Wook-Sung
WS
Chung
Ki-Bae
KB
Seung
D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000494:pharmacology; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000494:pharmacology*; D062645:Percutaneous Coronary Intervention; D011474:Prosthesis Design; D012042:Registries; D051437:Renal Insufficiency / Q000150:complications* / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D020123:Sirolimus / Q000494:pharmacology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus
paclitaxel-eluting stent; percutaneous coronary intervention; renal insufficiency; sirolimus-eluting stent