Tags

Type your tag names separated by a space and hit enter

Clinical outcomes following percutaneous coronary intervention with drug-eluting vs. bare-metal stents in dialysis patients.
J Invasive Cardiol. 2006 Dec; 18(12):577-83.JI

Abstract

BACKGROUND

Late mortality among dialysis patients undergoing PCI with bare-metal stents is high. The impact of drug-eluting stent use on outcomes in such patients is unclear.

OBJECTIVE

To compare the clinical outcomes of dialysis patients undergoing coronary stenting with versus without the use of drug-eluting stents.

METHODS

Baseline features and outcomes were compared in dialysis patients undergoing coronary stent implantation using either bare-metal devices only (n = 41) or drug-eluting stents (n = 33), in recruitment waves 3 (2001-2002; n = 2,047) and 4 (2004; n = 2,112) of the National Heart Lung, and Blood Institute Dynamic Registry. The primary study endpoint was the composite of major adverse cardiac events (MACE), defined as death, myocardial infarction (MI) or any repeat revascularization procedure at 1-year follow up.

RESULTS

Baseline and procedural features and in-hospital MACE rates were similar in both groups. Cumulative 1-year rates of the composite MACE endpoint and all-cause mortality were lower in patients treated with drug-eluting versus bare-metal stents (25.2% vs. 57.3%; p = 0.01, and 18.4% and 36.8%, respectively; p = 0.09). By multivariable analysis, drug-eluting versus bare-metal stent use was independently associated with freedom from the composite MACE endpoint (hazard ratio = 0.24, 95% CI [0.10-0.60]; p = 0.002) and with a trend to lower all-cause mortality (HR = 0.40 [0.15-1.05]; p = 0.06) at 1 year.

CONCLUSION

In this cohort of dialysis patients undergoing percutaneous coronary intervention (PCI), drug-eluting versus bare-metal stent implantation was associated with enhanced freedom from 1-year MACE. Given previous bare-metal stent data indicating worse outcomes after PCI than after bypass surgery in dialysis patients, randomized trials comparing these strategies in the drug-eluting stent era are needed.

Authors+Show Affiliations

Interventional Cardiology Department, Lenox Hill Hospital, New York, NY 10021, USA. ahalkin@netvision.net.ilNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17197706

Citation

Halkin, Amir, et al. "Clinical Outcomes Following Percutaneous Coronary Intervention With Drug-eluting Vs. Bare-metal Stents in Dialysis Patients." The Journal of Invasive Cardiology, vol. 18, no. 12, 2006, pp. 577-83.
Halkin A, Selzer F, Marroquin O, et al. Clinical outcomes following percutaneous coronary intervention with drug-eluting vs. bare-metal stents in dialysis patients. J Invasive Cardiol. 2006;18(12):577-83.
Halkin, A., Selzer, F., Marroquin, O., Laskey, W., Detre, K., & Cohen, H. (2006). Clinical outcomes following percutaneous coronary intervention with drug-eluting vs. bare-metal stents in dialysis patients. The Journal of Invasive Cardiology, 18(12), 577-83.
Halkin A, et al. Clinical Outcomes Following Percutaneous Coronary Intervention With Drug-eluting Vs. Bare-metal Stents in Dialysis Patients. J Invasive Cardiol. 2006;18(12):577-83. PubMed PMID: 17197706.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcomes following percutaneous coronary intervention with drug-eluting vs. bare-metal stents in dialysis patients. AU - Halkin,Amir, AU - Selzer,Faith, AU - Marroquin,Oscar, AU - Laskey,Warren, AU - Detre,Katherine, AU - Cohen,Howard, PY - 2007/1/2/pubmed PY - 2007/2/10/medline PY - 2007/1/2/entrez SP - 577 EP - 83 JF - The Journal of invasive cardiology JO - J Invasive Cardiol VL - 18 IS - 12 N2 - BACKGROUND: Late mortality among dialysis patients undergoing PCI with bare-metal stents is high. The impact of drug-eluting stent use on outcomes in such patients is unclear. OBJECTIVE: To compare the clinical outcomes of dialysis patients undergoing coronary stenting with versus without the use of drug-eluting stents. METHODS: Baseline features and outcomes were compared in dialysis patients undergoing coronary stent implantation using either bare-metal devices only (n = 41) or drug-eluting stents (n = 33), in recruitment waves 3 (2001-2002; n = 2,047) and 4 (2004; n = 2,112) of the National Heart Lung, and Blood Institute Dynamic Registry. The primary study endpoint was the composite of major adverse cardiac events (MACE), defined as death, myocardial infarction (MI) or any repeat revascularization procedure at 1-year follow up. RESULTS: Baseline and procedural features and in-hospital MACE rates were similar in both groups. Cumulative 1-year rates of the composite MACE endpoint and all-cause mortality were lower in patients treated with drug-eluting versus bare-metal stents (25.2% vs. 57.3%; p = 0.01, and 18.4% and 36.8%, respectively; p = 0.09). By multivariable analysis, drug-eluting versus bare-metal stent use was independently associated with freedom from the composite MACE endpoint (hazard ratio = 0.24, 95% CI [0.10-0.60]; p = 0.002) and with a trend to lower all-cause mortality (HR = 0.40 [0.15-1.05]; p = 0.06) at 1 year. CONCLUSION: In this cohort of dialysis patients undergoing percutaneous coronary intervention (PCI), drug-eluting versus bare-metal stent implantation was associated with enhanced freedom from 1-year MACE. Given previous bare-metal stent data indicating worse outcomes after PCI than after bypass surgery in dialysis patients, randomized trials comparing these strategies in the drug-eluting stent era are needed. SN - 1557-2501 UR - https://www.unboundmedicine.com/medline/citation/17197706/Clinical_outcomes_following_percutaneous_coronary_intervention_with_drug_eluting_vs__bare_metal_stents_in_dialysis_patients_ L2 - https://medlineplus.gov/kidneyfailure.html DB - PRIME DP - Unbound Medicine ER -