Abstract 17800: Very Long-term Outcomes (up To 8 Years) Of Patients With Renal Insufficiency Treated With Drug-eluting Stents
Background: Despite the marked benefits of PCI with DES, especially in complex scenarios, renal insufficiency (RI) remains as an independent predictor of negative outcomes in most series of patients treated with these devices. In clinical practice, the diagnostic of RI relies, most of the time, only on the levels of serum creatinine (Cr), which may underestimate the real incidence of this disease when compared to creatinine clearance (CrCl). We sought to compare the very long term clinical outcomes of patients with RI estimated by the Cr vs. CrCl when treated with PCI with DES.
Methods: Between May 2002 and Jan 2010, 3,320 consecutive patients treated in a single center with DES were divided into 3 groups according to their renal function:group I- normal renal function (n= 2,714); group II — Cr > 1.5mg/dL (n= 242), and; group III — Cr <1.5mg/dL and CrCl < 50ml/min (n= 364). These groups were compared regarding the very long term occurrence of MACE (cardiac death, MI and TLR) and stent thrombosis.
Results: Patients allocated to group III were more frequently female (58% vs. 19% in group I and 16.1% in group II, p< 0.001) with low body mass index (18.4 vs. 28.5 in group I and 26.8 in group II, p<0.001). Regarding mean age and incidence of DM, HAS, smoking, previous CAD and previous stroke, groups II and III were comparable and significantly worse than group I. Patients in groups II and III had also similar angiographic characteristics with higher percentage of severe coronary calcification (12.3% and 15% vs. 5.5%, p<0.001) and triple vessel disease (40% and 34.8% vs. 27.1%, p<0.001) when compared to group I. Clinical FU was achieved in 97.8% of the cases (mean FU time 3.6 years). Survival-free of MACE was comparable between groups II and III (80% vs. 85.4, p=0.2) and markedly worse than in group I (88.4%, p=0.02). Of note, patients with RI (groups II and III) had higher mortality and MI in their FU. Also, stent thrombosis rates were higher for those patients (2.2% in group II and 1.9% in group III vs. 1.4% in group I, p < 0.01).
Conclusions: The use of serum Cr to identify patients with RI may underestimate the occurrence of this serious illness in up to 60% of the cases. Notably, patients with “normal” Cr but impaired CrCl have poorer clinical outcomes when compared with those with normal renal function.
- © 2010 by American Heart Association, Inc.