1. Impact of renal insufficiency on safety and efficacy of drug-eluting stents compared to bare-metal stents at 6 years
- Author
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Cihan, Simsek, Michael, Magro, Eric, Boersma, Yoshinobu, Onuma, Sjoerd, Nauta, Gideon, Valstar, Robert-Jan, van Geuns, Willem, van der Giessen, Ron, van Domburg, Patrick, Serruys, Pieter C, Smits, Cardiology, and Radiology & Nuclear Medicine
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,Coronary Artery Disease ,Kaplan-Meier Estimate ,Kidney ,Severity of Illness Index ,chemistry.chemical_compound ,Risk Factors ,Medicine ,Registries ,Renal Insufficiency ,Angioplasty, Balloon, Coronary ,Netherlands ,Aged, 80 and over ,Hazard ratio ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,Treatment Outcome ,Metals ,Creatinine ,Female ,Stents ,Patient Safety ,Cardiology and Cardiovascular Medicine ,Glomerular Filtration Rate ,medicine.medical_specialty ,Paclitaxel ,Urology ,Renal function ,Prosthesis Design ,Risk Assessment ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Aged ,Proportional Hazards Models ,Sirolimus ,Chi-Square Distribution ,business.industry ,Stent ,Percutaneous coronary intervention ,Cardiovascular Agents ,Surgery ,chemistry ,Multivariate Analysis ,Cardiovascular agent ,business ,Chi-squared distribution ,Biomarkers ,Mace - Abstract
Background: There is few information on the long-term efficacy and safety of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) compared to bare metal stents (BMS) in all-comer percutaneous coronary intervention (PCI)patients complicated by renal insufficiency (RI). Objective: Our aim was to assess the 6-year clinical outcome of PCI-patients with RI treated exclusively with BMS, SES, or PES in our academic hospital. Methods: A total of 1382 patients, included in three cohorts of consecutive PCI-patients (BMS = 392; SES = 498; PES = 492), were categorized by creatinine clearance calculated by the CockroftGault formula (normal kidney function = 90; mild RI = 6089; moderate RI < 60) and systematically followed for the occurrence of major adverse cardiac events (MACE). Results: Mortality rates were significantly higher for patients with moderate RI compared to mild RI and normal kidney function at 6 years (KaplanMeier estimate: moderate RI (34%) vs. mild RI (12%), P < 0.001; moderate RI (34%) vs. normal kidney function (8%), P < 0.001). After multivariate Cox-regression analysis, SES and PES decreased the occurrence of target-vessel revascularization (TVR) and MACE at 6 years in patients with a normal creatinine clearance compared to BMS [adjusted hazard ratio (aHR) = 0.48, 95% CI: 0.280.84; aHR = 0.75, 95% CI: 0.570.97, respectively] with no significant effect on mortality. Safety- and efficacy end points were comparable for the three stent types in patients with mild- and moderate renal function. Conclusion: Patients with a normal creatinine clearance had significant improvement in TVR and MACE rates after SES- or PES implantation compared to BMS at 6 years. However, there was no superiority of both drug-eluting stents over BMS in safety and efficacy end points for patients with impaired renal function. (c) 2012 Wiley Periodicals, Inc.
- Published
- 2012