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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.

Short- and long-term data showed that drug-eluting stents (DES) significantly decreased target vessel revascularization (TVR) and major adverse cardiac event (MACE) rates compared to bare-metal stents (BMS). However, conflicting long-term data remain for patients with ST-segment elevation myocardial infarction (STEMI).Our aim was to assess the 6-year clinical outcome of all patients undergoing primary percutaneous coronary intervention (PPCI) for a de novo lesion with exclusive use of BMS, sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES).Three PPCI cohorts (BMS = 80; SES = 92; PES = 162) were systematically followed for the occurrence of MACE.Very late stent thrombosis was more common after the implantation of SES as compared to PES or BMS (7.6%, 0.6%, and 0.0%, respectively; p = 0.001). Kaplan-Meier estimates indicate no statistically significant difference for mortality between the three stent types at 6 years (BMS = 25%; SES = 15%; PES = 21%; Log-rank p = 0.2). After adjustment for differences in baseline characteristics, mortality, mortality/myocardial infarction (MI), and MACE rates were significantly lower for SES compared to BMS, but not for PES (aHR = 0.41, 95% CI: 0.17-0.98; aHR = 0.44, 95% CI: 0.21-0.96; aHR = 0.35, 95% CI: 0.17-0.72, respectively). No differences were observed between the three stent types for TVR rates.Neither SES nor PES improved safety or efficacy as compared to BMS in a STEMI population at 6 years. After adjusting, the usage of SES resulted in a significant decrease in mortality, mortality/MI and MACE rates as compared to BMS, in contrast to the usage of PES. SES and PES have a similar effectiveness and safety profile, although very late stent thrombosis was more common with SES.

After treatment with intracoronary brachytherapy, enlargement of lumen (negative late loss) at follow-up has been demonstrated. The aim of the study is to analyze the sensitivity and specificity of quantitative coronary angiography (QCA) parameters to detect a positive vessel remodeling after intracoronary -radiation as compared to intravascular ultrasound (IVUS).Twenty-seven patients (27 vessels) treated with balloon angioplasty followed by catheter-based intracoronary -radiation with a (90)Strontium/(90)Yttrium source were assessed by both QCA and three-dimensional IVUS with electrocardiogram-gated pullback. Irradiated segments were analyzed over the total treatment length and in subsegment lengths of 5 mm.Change in minimum luminal diameter (MLD) was not a predictor for the positive remodeling in either total irradiated segments or 5 mm subsegments, with a 54.3% ROC curve area [95% confidence interval (CI), 30-79%], sensitivity of 39% and specificity of 44% (p = not significant) in the total irradiated segments and a 55.9% ROC curve area (95% CI, 46-66%), sensitivity of 55% and specificity of 54% (p = not significant) in the 5 mm subsegments. Changes in mean and maximal lumen diameter were not significant parameters to detect positive vessel remodeling. When only central subsegments were analyzed, change in MLD was a significant predictor, with a 63.3% ROC curve area (95% CI, 52-75%), sensitivity of 55% and specificity of 64% (p = 0.029).Lumen enlargement detected by QCA does not reliably indicate a positive vessel remodeling after intracoronary radiation. IVUS analysis may be necessary to investigate the mechanism of restenosis after balloon angioplasty followed by catheter-based radiation.