Document Detail

Relationship between severity of renal impairment and 2-year outcomes after sirolimus-eluting stent implantation.
MedLine Citation:
PMID:  19540397     Owner:  NLM     Status:  MEDLINE    
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.
Tomoyuki Ota; Hisashi Umeda; Shigeki Yokota; Shinjiro Miyata; Atsushi Takamura; Shigeo Sugino; Kazutaka Hayashi; Ryoji Ishiki; Yasushi Takeichi; Mitsunori Iwase; Haruo Inagaki; Toyoaki Murohara
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  158     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-22     Completed Date:  2009-07-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  92-8     Citation Subset:  AIM; IM    
Division of Cardiology, Toyota Memorial Hospital, 1-1 Heiwa-cho, Toyota, Japan.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Cause of Death
Coronary Angiography
Coronary Restenosis / etiology*,  mortality
Disease-Free Survival
Drug-Eluting Stents*
Equipment Failure Analysis
Follow-Up Studies
Glomerular Filtration Rate / physiology
Kaplan-Meiers Estimate
Kidney Failure, Chronic / complications*,  diagnosis,  mortality,  therapy
Middle Aged
Multivariate Analysis
Myocardial Infarction / diagnosis,  mortality,  therapy*
Proportional Hazards Models
Renal Dialysis
Risk Factors
Sirolimus / administration & dosage*
Reg. No./Substance:

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