Stent Type and Outcomes in Dialysis Patients
What are the mortality and cardiovascular morbidity rates during percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and with bare-metal stents (BMS) in dialysis patients?
The investigators identified 36,117 dialysis patients from the U.S. Renal Data System who had coronary stenting in the United States between April 23, 2003, and December 31, 2010, and examined the association of DES versus BMS with 1-year outcomes: death; death or MI; and death, MI, or repeat revascularization. They conducted a temporal analysis by dividing the study period into three DES eras: Transitional (April 23, 2003, to June 30, 2004); Liberal (July 1, 2004, to December 31, 2006); and Selective (January 1, 2007, to December 31, 2010).
One-year event rates were high, with 38 deaths; 55 death or MI events; and 71 death, MI, or repeat revascularization events per 100 person-years. DES was associated with a significant 18% lower risk of death; 16% lower risk of death or MI; and 13% lower risk of death, MI, or repeat revascularization, compared with BMS. DES use varied, from 56% in the Transitional era to 85% in the Liberal era and 62% in the Selective era. DES outcomes in the Liberal era were significantly better than in the Transitional era, but not significantly better than in the Selective era.
The authors concluded that DES for PCI appear safe in U.S. dialysis patients, and is associated with lower rates of death, MI, and repeat revascularization.
This study reports that use of DES rather than BMS during PCI in patients with end-stage renal disease (ESRD) on dialysis was associated with 18% lower risk of death; 6% lower risk of death or MI; and 13% lower risk of death, MI, or repeat revascularization. These data provide additional evidence to support current guidelines recommending preferential use of DES over BMS in this high-risk patient population. Future DES trials should include patients across a broad range of kidney function, including patients with ESRD on dialysis, to provide more definitive evidence regarding safety and efficacy of these devices in ESRD patients.
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