Association Between Drug-Eluting Stent Type and Clinical Outcomes in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention

作者：Chan William; Ivanov Joan; Kotowycz Mark A; Sibbald Matthew; McGeoch Ross; Crooks Noel; Hatton Rachael; Ing Douglas; Daly Paul; Mackie Karen; Osten Mark D; Seidelin Peter H; Barolet Alan; Overgaard Christopher B; Dzavik Vladimir

来源：Canadian Journal of Cardiology, 2014, 30(10): 1170-1176.

DOI：10.1016/j.cjca.2014.04.034

Background: The comparative efficacy of first-vs second-generation drug-eluting stents (DESs) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) is unknown.
Methods: A retrospective analysis of consecutive patients undergoing PCI at a tertiary PCI center from 2007-2011 was performed, with linkage to administrative databases for long-term outcomes. CKD was defined as creatinine clearance (CrCl) < 60 mL/min. Propensity matching by multivariable scoring method and Kaplan-Meier analyses were performed.
Results: Of 6481 patients with available CrCl values undergoing a first PCI during the study period, 1658 (25%) had CKD. First-and second-generation DESs were implanted in 320 (19.3%) and 128 (7.7%) patients with CKD, respectively. At 2 years, no significant differences were observed between first-generation (n = 126) and second-generation (n = 126) propensity-matched DES cohorts for the outcomes of death (19% vs 16%; P = 0.51), repeat revascularization (10% vs 10%; P = 1.00), and major adverse cardiovascular and cerebrovascular events (MACCE) (36% vs 37%; P = 0.90). The 2-year Kaplan-Meier survival was also similar (P = 0.77). In patients with CKD, second-generation DES type was not an independent predictor for death (P = 0.49) or MACCE (P = 1.00).
Conclusions: Although the use of first-and second-generation DESs was associated with similar 2-year safety and efficacy in patients with CKD, our results cannot rule out a beneficial effect of second-vs first-generation DESs owing to small sample size. Future studies with larger numbers of patients with CKD are needed to identify optimal stent types, which may improve long-term clinical outcomes.

• 出版日期2014-10