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Relationship between severity of renal impairment and 2-year outcomes after sirolimus-eluting stent implantation.
Am Heart J. 2009 Jul; 158(1):92-8.AH

Abstract

BACKGROUND

The presence of chronic kidney disease (CKD) is associated with an increased risk of restenosis and major adverse cardiac events (MACEs) after coronary interventions, especially in patients on hemodialysis (HD). The aim of this study was to assess the impact of varying degrees of renal impairment on angiographic and 2-year clinical outcomes after treatment with sirolimus-eluting stents (SESs).

METHODS

A total of 675 lesions of 593 patients treated with SES were analyzed. Patients were classified into 3 groups: 34 patients on HD; 337 patients with estimated glomerular filtration rate > or =60 mL min(-1) 1.73 m(-2) (non-CKD group); and 222 patients who had lower estimated glomerular filtration rate <60 mL min(-1) 1.73 m(-2) without HD dependency (CKD group).

RESULTS

At angiographic follow-up (201 +/- 73 days), in-segment late loss was markedly higher in the HD group versus the non-CKD and CKD groups (0.68 +/- 1.06 vs 0.11 +/- 0.45 and 0.15 +/- 0.50 mm, respectively, P < .001), resulting in a significantly higher in-segment restenosis rate (40.0% vs 10.4% and 11.5%, respectively, P < .001). At 2 years, HD vs non-CKD and CKD was associated with a significantly higher MACE rate (35.3% vs 10.4% and 12.6%, respectively, P < .001), mainly driven by significantly higher mortality (11.8% vs 0.6% and 2.3%, respectively, P < .001) and target-lesion revascularization (23.5% vs 9.2% and 8.1%, respectively, P = .016) rates. Multivariable analysis revealed that HD was the independent predictor of 2-year MACE (hazard ratio 4.70, 95% CI 2.40-9.20, P < .001).

CONCLUSIONS

Although angiographic and clinical outcomes after SES implantation were similarly favorable in non-HD-dependent CKD patients, regardless of renal function, in patients with end-stage CKD requiring HD, frequencies of restenosis and 2-year MACE were markedly higher than in non-HD-dependent patients.

Authors+Show Affiliations

Division of Cardiology, Toyota Memorial Hospital, 1-1 Heiwa-cho, Toyota, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

19540397

Citation

Ota, Tomoyuki, et al. "Relationship Between Severity of Renal Impairment and 2-year Outcomes After Sirolimus-eluting Stent Implantation." American Heart Journal, vol. 158, no. 1, 2009, pp. 92-8.
Ota T, Umeda H, Yokota S, et al. Relationship between severity of renal impairment and 2-year outcomes after sirolimus-eluting stent implantation. Am Heart J. 2009;158(1):92-8.
Ota, T., Umeda, H., Yokota, S., Miyata, S., Takamura, A., Sugino, S., Hayashi, K., Ishiki, R., Takeichi, Y., Iwase, M., Inagaki, H., & Murohara, T. (2009). Relationship between severity of renal impairment and 2-year outcomes after sirolimus-eluting stent implantation. American Heart Journal, 158(1), 92-8. https://doi.org/10.1016/j.ahj.2009.04.013
Ota T, et al. Relationship Between Severity of Renal Impairment and 2-year Outcomes After Sirolimus-eluting Stent Implantation. Am Heart J. 2009;158(1):92-8. PubMed PMID: 19540397.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between severity of renal impairment and 2-year outcomes after sirolimus-eluting stent implantation. AU - Ota,Tomoyuki, AU - Umeda,Hisashi, AU - Yokota,Shigeki, AU - Miyata,Shinjiro, AU - Takamura,Atsushi, AU - Sugino,Shigeo, AU - Hayashi,Kazutaka, AU - Ishiki,Ryoji, AU - Takeichi,Yasushi, AU - Iwase,Mitsunori, AU - Inagaki,Haruo, AU - Murohara,Toyoaki, PY - 2009/02/18/received PY - 2009/04/02/accepted PY - 2009/6/23/entrez PY - 2009/6/23/pubmed PY - 2009/7/8/medline SP - 92 EP - 8 JF - American heart journal JO - Am. Heart J. VL - 158 IS - 1 N2 - BACKGROUND: The presence of chronic kidney disease (CKD) is associated with an increased risk of restenosis and major adverse cardiac events (MACEs) after coronary interventions, especially in patients on hemodialysis (HD). The aim of this study was to assess the impact of varying degrees of renal impairment on angiographic and 2-year clinical outcomes after treatment with sirolimus-eluting stents (SESs). METHODS: A total of 675 lesions of 593 patients treated with SES were analyzed. Patients were classified into 3 groups: 34 patients on HD; 337 patients with estimated glomerular filtration rate > or =60 mL min(-1) 1.73 m(-2) (non-CKD group); and 222 patients who had lower estimated glomerular filtration rate <60 mL min(-1) 1.73 m(-2) without HD dependency (CKD group). RESULTS: At angiographic follow-up (201 +/- 73 days), in-segment late loss was markedly higher in the HD group versus the non-CKD and CKD groups (0.68 +/- 1.06 vs 0.11 +/- 0.45 and 0.15 +/- 0.50 mm, respectively, P < .001), resulting in a significantly higher in-segment restenosis rate (40.0% vs 10.4% and 11.5%, respectively, P < .001). At 2 years, HD vs non-CKD and CKD was associated with a significantly higher MACE rate (35.3% vs 10.4% and 12.6%, respectively, P < .001), mainly driven by significantly higher mortality (11.8% vs 0.6% and 2.3%, respectively, P < .001) and target-lesion revascularization (23.5% vs 9.2% and 8.1%, respectively, P = .016) rates. Multivariable analysis revealed that HD was the independent predictor of 2-year MACE (hazard ratio 4.70, 95% CI 2.40-9.20, P < .001). CONCLUSIONS: Although angiographic and clinical outcomes after SES implantation were similarly favorable in non-HD-dependent CKD patients, regardless of renal function, in patients with end-stage CKD requiring HD, frequencies of restenosis and 2-year MACE were markedly higher than in non-HD-dependent patients. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19540397/Relationship_between_severity_of_renal_impairment_and_2_year_outcomes_after_sirolimus_eluting_stent_implantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00285-3 DB - PRIME DP - Unbound Medicine ER -