Study Looks at Long-term Outcomes of DES Use in Patients With RI
July 14, 2009 – Despite the fact that drug-eluting stent (DES) implantation reduces restenosis and the need for target vessel revascularization (TVR), these stents appear to be associated with unfavorable long-term outcomes in patients with moderate or severe renal insufficiency (RI), according to a study in this week’s issue of the International Journal of Cardiology, Volume 136, Issue 1, pages 72-79, July 2009.
Researchers at Rui Jin Hospital and Jiao Tong University School of Medicine in Shanghai, China, sought to examine the impact of moderate or severe RI on long-term clinical outcomes after successful percutaneous coronary intervention (PCI) with drug-eluting stent implantation. They found all-cause mortality and major adverse cardiac events were prospectively determined for 1,174 patients after successful PCI with drug-eluting stent implantation. Based on estimated creatinine clearance (CrCl) levels, long-term outcomes were compared between patients with CrCl<60 ml/min (RI group; n=460) and those with CrCl≥60 ml/min (control group; n=714). Hazard ratio for mortality and myocardial infarction was further evaluated for patients with severe (CrCl<30 ml/min), moderate (CrCl 30–59 ml/min), mild RI (CrCl 60–89 ml/min) and normal renal function (CrCl≥90 ml/min).
Patients in the RI group were older, mainly female and had lower body weights and hemoglobin than those in the control group. The RI group also had fewer cigarette smokers. During follow-up (averaged 19.2 months) after successful PCI, all-cause death (8.3 percent vs. 1.5 percent), cardiac death (5.7 percent vs. 1.1 percent) and occurrence of nonfatal myocardial infarction (2.2 percent vs. 0.4 percent) were significantly higher, but the rate of TVR was lower (5.7 percent vs. 9.6 percent) in the RI group than in the control group. Multivariate analysis revealed that a CrCl<60 ml/min, diabetes, a left ventricular ejection fraction less than 0.50 and anemia were independent risk factors for mortality and nonfatal myocardial infarction. Compared with patients with normal renal function, the hazard ratio for a composite of mortality and myocardial infarction was 1.079, 5.067 and 8.828 in patents with mild, moderate and severe RI, respectively.
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