title: Impact of stent type and prolonged dual antiplatelet therapy on long-term clinical outcomes in hemodialysis patients with coronary artery disease.
abstract: The aim of this study was to address 7-year clinical outcomes and impact of prolonged dual antiplatelet therapy (DAPT) after coronary stenting in hemodialysis patients. Our study included 123 consecutive hemodialysis patients who had undergone percutaneous coronary intervention with a drug-eluting stent (DES) or bare-metal stent (BMS) (DES: 64, BMS: 59) in our institution. We compared long-term clinical outcomes following DES with BMS implantation as well as clinical outcomes in patients on DAPT for ≥1 year (DAPT on group, 89) with those on DAPT for <1 year (DAPT off group, 34). We evaluated bleeding events and major adverse cardiac events (MACE), including cardiac death, non-fatal myocardial infarction, target vessel revascularization, and stent thrombosis. At 1 year after stenting, the incidence of MACE was significantly lower in the DES group than in the BMS group (DES versus BMS: 33.2 versus 51.8%; p = 0.045). However, this advantage of DES disappeared by the 7th year (DES versus BMS: 66.0 versus 70.0%; p = 0.42). The cumulative incidence of MACE beyond 1 year was significantly higher in the DAPT on group than in the DAPT off group (DAPT on versus DAPT off: 51.3 versus 18.5%; p = 0.047). The bleeding events in the DAPT on group were 5.1 times greater than in the DAPT off group (DAPT on versus DAPT off: 16.4 versus 3.2%; p = 0.06). Use of DES and prolonged DAPT did not improve 7-year clinical outcomes in hemodialysis patients with coronary artery disease.
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan. asami560725@yahoo.co.jp.
authors.forename: Masahiko
authors.identifier: http://orcid.org/0000-0002-2102-033X
authors.initials: M
authors.lastname: Asami
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Aoki
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Sato
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Shuzou
authors.initials: S
authors.lastname: Tanimoto
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Horiuchi
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Furui
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yasuhara
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Hashimoto
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Sen
authors.initials: S
authors.lastname: Yachi
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hara
authors.affiliation: Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Tanabe
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D006435:Renal Dialysis; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Coronary artery disease; Drug-eluting stent; Dual antiplatelet therapy; Hemodialysis; Long-term outcome