Clinical and Angiographic Outcomes Following Percutaneous Coronary Intervention With Sirolimus-Eluting Stents Versus Bare-Metal Stents in Hemodialysis Patients
Received 18 August 2008; accepted 30 January 2009. published online 27 April 2009.
Refers to article:
Drug-Eluting Stents in Patients With ESRD on Dialysis: A Small Step Forward
Khaled M. Ziada, Ahmed Abdel-Latif
American Journal of Kidney Diseases
August 2009 (Vol. 54, Issue 2, Pages 197-200) Full Text |
Full-Text PDF (140 KB)
Background
Percutaneous coronary intervention for hemodialysis patients has been hampered by the high rate of adverse cardiac events. Our aim was to investigate whether sirolimus-eluting stents (SESs) improve clinical outcomes of hemodialysis patients compared with bare-metal stents (BMSs).
Study Design
Retrospective study.
Setting & Participants
123 consecutive patients on hemodialysis therapy treated with either an SES or BMS. There were 56 patients with 68 lesions treated with SESs between August 2004 and April 2006 (SES group) and 67 patients with 71 lesions treated with BMSs 4 years before approval of SESs in Japan (BMS group).
Predictor
SES and BMS implantation for hemodialysis patients with coronary artery disease.
Outcomes & Measurements
Follow-up angiography was performed at 6 to 8 months and clinical follow-up was obtained at 9 months after the procedure. Late lumen loss and major adverse cardiac events, including all-cause death, myocardial infarction, and target-lesion revascularization, were investigated.
Results
Clinical follow-up was obtained in all patients. Angiographic follow-up was obtained in 50 patients (89.3%) in the SES group and 50 patients (74.6%) in the BMS group. The SES group had more complex lesions than the BMS group. Quantitative angiographic analysis showed a significant difference for in-stent late lumen loss (SES, 0.62 ± 0.75 mm; BMS, 1.07 ± 0.75 mm; P = 0.003). Of angiographic restenosis lesions analyzed, a focal restenotic pattern was observed more frequently in the SES group than the BMS group (SES, 87.5%; BMS, 23.8%; P < 0.001). The rate of major adverse cardiac events was significantly lower in the SES group (n = 14; 25.0%) than the BMS group (n = 26; 38.9%; log-rank P = 0.02).
Limitations
Retrospective study design, small sample size, and a single-center study.
Conclusions
Clinical and angiographic data in the present study suggest that SESs are more effective than BMSs in hemodialysis patients.
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