Drug-Eluting Stents in Patients with Chronic Kidney Disease: A Prospective Registry StudyReportar como inadecuado




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Background

Chronic kidney disease CKD is strongly associated with adverse outcomes after percutaneous coronary intervention PCI. There are limited data on the effectiveness of drug-eluting stents DES in patients with CKD.

Methodology-Principal Findings

Of 3,752 consecutive patients enrolled in the Guthrie PCI Registry between 2001 and 2006, 436 patients with CKD - defined as a creatinine clearance <60 mL-min - were included in this study. Patients who received DES were compared to those who received bare metal stents BMS. Patients were followed for a mean duration of 3 years after the index PCI to determine the prognostic impact of stent type. Study end-points were all-cause death, myocardial infarction MI, target vessel revascularization TVR, stent thrombosis ST and the composite of major adverse cardiovascular events MACE, defined as death, MI or TVR. Patients receiving DES in our study, by virtue of physician selection, had more stable coronary artery disease and had lower baseline risk of thrombotic or restenotic events. Kaplan-Meier estimates of proportions of patients reaching the end-points were significantly lower for DES vs. BMS for all-cause death p = 0.0008, TVR p = 0.029 and MACE p = 0.0015, but not MI p = 0.945 or ST p = 0.88. Multivariable analysis with propensity adjustment demonstrated that DES implantation was an independent predictor of lower rates of all-cause death hazard ratio HR 0.48, 95% confidence interval CI 0.25–0.92, TVR HR 0.50, 95% CI 0.27–0.94 and MACE HR 0.62, 95% CI 0.41–0.94.

Conclusions

In a contemporary PCI registry, selective use of DES in patients with CKD was safe and effective in the long term, with lower risk of all-cause death, TVR and MACE and similar risk of MI and ST as compared with BMS. The mortality benefit may be a result of selection bias and residual confounding, or represent a true finding; a hypothesis that warrants clarification by randomized clinical trials.



Autor: Chetan Shenoy, Judy Boura, Pamela Orshaw, Kishore J. Harjai

Fuente: http://plos.srce.hr/



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