Abstract 2537: Two-year Outcomes With Sirolimus-Eluting Stent In Dialysis Patients
Background: The long term efficacy of sirolimus-eluting stents (SES) has not been established in dialysis patients.
Methods and Results: This study is an observational single-center registry in a community hospital. We enrolled 704 consecutive patients who underwent PCI with SES (Dialysis 88 pts, non-dialysis 616 pts) and compared with the historical group of consecutive 1123 patients treated with bare-metal stents (BMS; dialysis 125 pts, non-dialysis 998 pts). Patients with 2nd or further registration in the same period, patients with acute myocardial infarction, and patients with in stent restenosis were excluded. After two year, the unadjusted cumulative incidences of major adverse cardiac events (MACE), comprising cardiac death, myocardial infarction, stent thrombosis, or target lesion revascularization (TLR), were 14.7 % in the SES group and 28.9 % in the BMS group in non-dialysis patients(p <.0001), and were 32.7 % in the SES group and 46.1 % in the BMS group in dialysis patients(p = 0.038). After adjusting for confounders, use of SES was related to the reduction of composite MACE in both non-dialysis and dialysis patients (HR 0.58, 95% CI 0.51– 0.68, p<.0001 in non-dialysis; HR0.68, 95%CI 0.53– 0.88, P=0.0027 in dialysis). In subgroup analysis for angiographic binary restenosis, only lesions in dialysis patients (20% vs. 31%, P=0.085) and those with angiographic severe calcification (24% vs. 30%, P=0.29) were not associated with significant difference between the SES group and the BMS group.
Conclusions: In dialysis patients, the implantation of SES was moderately effective in reducing MACE at two year after PCI as compared with that of BMS. However, lesions in dialysis patients and heavily calcified lesions showed limited effect of SES for reducing restenosis.