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Randomized Comparison of XiEnce-V and Multi-link VisioN Coronary Stents in the sAme muLtivessel Patient with Chronic kiDnEy diSease (RENAL-DES) Study
Study Questions:
What is the benefit of drug-eluting stents (DES) in patients with chronic kidney disease (CKD)?
Methods:
The RENAL-DES trial authors performed a prospective, randomized, multicenter study to directly compare the efficacy in the prevention of clinical restenosis of everolimus-eluting stent (Xience-V) and BMS with identical design (Multi-link Vision), both implanted in the same patient with multivessel coronary artery disease and CKD (estimated glomerular filtration rate <60 ml/min). The primary endpoint of the study was the ischemia-driven target vessel revascularization (ID-TVR), as detected with myocardial scintigraphy at 12 months.
Results:
In 215 patients, 512 coronary vessels were successfully treated with the randomly assigned DES (n = 257) or BMS (n = 255). At 1 year, randomization to DES was associated with a reduction in the rate of ID-TVR (2.7% vs. 11.4%, p < 0.001). In multivariate analysis, independent predictors of the ID-TVR were BMS implantation (odds ratio [OR], 4.95; 95% confidence interval [CI], 2.1-11.6; p < 0.001) and vessel size (OR, 0.32; 95% CI, 0.1-0.7; p = 0.006).
Conclusions:
The authors concluded that use of DES is associated with a reduction in TVR in patients with CKD.
Perspective:
The anti-restenotic efficacy of DES has been established in multiple studies, and subgroup analysis of larger trials has confirmed the benefit of DES in patients with renal impairment (e.g., Garg, Am J Cardiol 2010;106:1436-42). This small study is corroborative in nature, and supports the use of second-generation DES in patients with CKD.
Keywords: Myocardial Perfusion Imaging, Coronary Artery Disease, Multivariate Analysis, Drug-Eluting Stents, Glomerular Filtration Rate, Renal Insufficiency, Chronic
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