Document Detail


Impact of baseline renal function on mortality after percutaneous coronary intervention with sirolimus-eluting stents or bare metal stents.
MedLine Citation:
PMID:  15642546     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Renal impairment is an important predictor of mortality after percutaneous coronary intervention and may increase the restenosis rate. However, the relation between restenosis and the risk of death in patients who have renal impairment remains unclear. We evaluated the incidences of repeat revascularization and mortality in patients who had renal impairment and those who did not and who received sirolimus-eluting stents or bare stents. A total of 1,080 consecutive patients treated for 1 year had available data to calculate baseline creatinine clearance. Patients received bare stents (first 6 months, n = 543) or sirolimus-eluting stents (last 6 months, n = 537) and were grouped according to the presence or absence of renal impairment (creatinine clearance <60 ml/min). Patients who had renal impairment had a higher mortality rate at 1 year (7.6% vs 2.5%, hazard ratio 3.14, 95% confidence interval 1.68 to 5.88, p <0.01), with no differences in mortality between patients who received bare stents and those who received sirolimus-eluting stents (hazard ratio 0.91, 95% confidence interval 0.49 to 1.68, p = 0.8). The incidence of target vessel revascularization decreased significantly in patients who were treated with sirolimus-eluting stents and did not have renal impairment (hazard ratio 0.59, 95% confidence interval 0.39 to 0.90, p = 0.01) and in those who had decreased renal function (hazard ratio 0.37, 95% confidence interval 0.15 to 0.90, p = 0.03). Thus, sirolimus-eluting stents compared with conventional stents decreased clinical restenosis in patients who had renal impairment. However, this benefit was not paralleled by a decrease in the risk of death in this population. It seems unlikely that restenosis could be a contributing factor that influenced the increased mortality of patients who had impaired renal function.
Authors:
Pedro A Lemos; Chourmouzios A Arampatzis; Angela Hoye; Joost Daemen; Andrew T L Ong; Francesco Saia; Willem J van der Giessen; Eugene P McFadden; Georgios Sianos; Pieter C Smits; Pim de Feyter; Sjoerd H Hofma; Ron T van Domburg; Patrick W Serruys
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  95     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2005-01-11     Completed Date:  2005-02-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  167-72     Citation Subset:  AIM; IM    
Affiliation:
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Stenosis / complications,  mortality,  pathology,  radiography,  therapy*
Female
Humans
Immunosuppressive Agents / administration & dosage*
Kidney Failure, Chronic / complications*,  physiopathology
Kidney Function Tests
Male
Middle Aged
Netherlands
Severity of Illness Index
Sirolimus / administration & dosage*
Stents*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 53123-88-9/Sirolimus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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