Abstract 13516: Drug Eluting Stents versus Bare Metal Stents for Coronary Intervention in Chronic Hemodialysis Patients from Long-Term Clinical Follow-up Study
Background: In drug-eluting stent (DES) era, the restenosis rate after percutaneous coronary intervention (PCI) had been dramatically reduced. However, short-term restenosis after PCI are frequently seen in patients on hemodialysis (HD) even if treated with DES. Until now, there have been limited reports regarding long-term clinical outcome after DES implantation in this population.
Methods: Consecutive 266 HD patients (280 lesions) who underwent exclusively with DES implantation (DES group) were compared to 153 HD patients (160 lesions) who received bare metal stents implantation during the preceding 4 years (BMS group). We analyzed incidence of major adverse cardiac events (MACE) including target lesion revascularization (TLR), non-fatal myocardial infarction (MI) and cardiovascular (CV) death.
Results: All patients received successful PCI. Baseline clinical characteristics were similar between the two groups. 81 MACE (46 TLR, 5 MI and 30 CV deaths) in BMS group and 81 MACE (46 TLR, 4 MI and 31 CV deaths) in DES group occurred during each follow-up period, respectively. The 4-year freedom rate from MACE was 59.1% in DES group and 46.9% in BMS group (p=0.0074) with Kaplan-Meier analysis (Figure). After adjustment for gender, age, traditional risk factors, history of CV disease, multi-vessel disease and ACC/AHA type, DES implantation was independently associated with a reduction of MACE [hazard ration (HR) 0.67, p=0.018]. The freedom rate from TLR for 4 years was also significantly higher in the DES group than in the BMS group (72.8% vs. 61.9%, p=0.014), and DES was an independent predictor for preventing TLR (HR 0.66, p= 0.044) (Figure). The freedom from MI and CV death were comparable between DES and BMS group (97.8% vs. 95.9%, p=0.25 and 80.1% vs. 75.2%, p=0.40, respectively).
Conclusions: DES implantation contributed to reduce MACE for long-term follow-up compared to BMS in patients on HD even if its outcome is poorer than that of general population.
- © 2010 by American Heart Association, Inc.