Abstract 1685: Clinical and Angiographic Outcomes following Percutaneous Coronary Intervention with Sirolimus-Eluting Stents vs. Bare Metal Stents in Hemodialysis Patients
Background Percutaneous coronary intervention in hemodialysis patients has been hampered by high rate of major adverse cardiac events (MACE). It remains uncertain whether sirolimus-eluting stent (SES) improves clinical outcomes in hemodialysis patients compared to bare metal stent (BMS).
Methods The present study consisted of consecutive 46 hemodialysis patients with 57 lesions treated with SES from August 2004 to April 2006. For comparison, the control group was composed of 67 hemodialysis patients with 70 lesions who were treated with BMS in three years before the introduction of SES. Clinical and angiographic follow-up were performed after 8 months. MACE included all-cause death, myocardial infarction and repeat target vessel revascularization.
Results Baseline characteristics were comparable between the 2 groups except for lesion length. Clinical follow-up was available in all patients. Angiographic follow-up was obtained in 39 patients (84.8%) in the SES group and 49 patients (73.1%) in the BMS group. There was no difference in MACE between the 2 groups (SES;28.3%, BMS;40.3%, p=0.19). As shown in the table⇓, quantitative angiographic analysis revealed a significant difference in late lumen loss (SES;0.66±0.80mm, BMS;1.07±0.75mm, p=0.01), however, the rate of binary restenosis was identical (SES;31.9%, BMS;40.4%, p=0.38). Of the angiographic restenosis lesions analyzed, focal restenosis pattern was frequently observed in the SES group than the BMS group(SES;93.3%, BMS;23.8%, p<0.0001), whereas diffuse restenosis pattern was dominant in the BMS group.
Conclusion Angiographic parameters favored inhibition of neointimal hyperplasia by SES. However, the inhibitory effect of sirolimus was not translated into clinical superiority over BMS in hemodialysis patients.