Korean Circ J.  2012 Dec;42(12):830-838. 10.4070/kcj.2012.42.12.830.

Coronary Stents in Patients with ST-Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention

• Ahmed K
• Jeong MH
• Chakraborty R
• Ahmed S
• Hong YJ
• Sim DS
• Park KH
• Kim JH
• Ahn Y
• Kang JC
• Cho MC
• Kim CJ
• Kim YJ
• Other Korea Acute Myocardial Infarction Registry Investigators

• KMID: 1491099
• DOI: http://doi.org/10.4070/kcj.2012.42.12.830

Abstract

BACKGROUND AND OBJECTIVES
Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). We sought to compare different coronary stents used during primary PCI in patients with ST-elevation myocardial infarction (STEMI) and CKD.
SUBJECTS AND METHODS
We selected 2408 consecutive STEMI patients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) undergoing primary PCI and divided them into 5 groups based on the type of stent implanted: 1) bare metal stent (BMS), 2) paclitaxel-eluting stent (PES), 3) sirolimus-eluting stent (SES), 4) zotarolimus-eluting stent (ZES), or 5) everolimus-eluting stent (EES). The study endpoint was the number of major adverse cardiac events (MACE) at 12 months.
RESULTS
There was no significant difference in the incidence of 12-month myocardial infarction, target lesion revascularization, or target vessel revascularization between stent groups; however, the overall rate of repeat revascularization differed significantly between groups. All-cause death differed significantly among the groups. The incidence of 12-month MACE in BMS, PES, SES, ZES, and EES was 8.3%, 9.8%, 8.6%, 5.5%, and 2.6%, respectively (p<0.001). Kaplan-Meier analysis did not show a significant differences in 12-month MACE-free survival among the groups (log-rank p=0.076). This finding remained the same after adjusting for multiple confounders (p=0.147).
CONCLUSION
Any of the 5 stents can be used to treat STEMI patients with CKD undergoing primary PCI; all have similar risk of 12-month MACE. This result is hypothesis-generating and warrants further evaluation with a long-term randomized study.

Keyword

Myocardial infarction; Stents; Angioplasty; Kidney failure, chronic

MeSH Terms

Angioplasty
Glomerular Filtration Rate
Glycosaminoglycans
Humans
Incidence
Kaplan-Meier Estimate
Kidney Failure, Chronic
Myocardial Infarction
Percutaneous Coronary Intervention
Renal Insufficiency, Chronic
Stents
Glycosaminoglycans

Figure

• 

  Fig. 1 Kaplan-Meier curves for 12-month MACE-free survival for patients with STEMI and CKD undergoing primary PCI treated with 5 commonly used stent types. MACE: major adverse cardiac events, STEMI: ST-elevation myocardial infarction, CKD: chronic kidney disease, PCI: percutaneous coronary intervention, BMS: bare metal stent, PES: paclitaxel-eluting stent, SES: sirolimus-eluting stent, ZES: zotarolimus-eluting stent, EES: everolimus-eluting stent.

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  Fig. 2 Adjusted 12-month MACE-free survival in patients with STEMI and CKD undergoing primary PCI using 5 types of commonly used stents. MACE: major adverse cardiac events, STEMI: ST-elevation myocardial infarction, CKD: chronic kidney disease, PCI: percutaneous coronary intervention, BMS: bare metal stent, PES: paclitaxel-eluting stent, SES: sirolimus-eluting stent, ZES: zotarolimus-eluting stent, EES: everolimus-eluting stent.

• 

  Fig. 3 Propensity adjusted 12-month MACE-free survival in patients with STEMI and CKD undergoing primary PCI using 5 types of commonly used stents. MACE: major adverse cardiac events, STEMI: ST-elevation myocardial infarction, CKD: chronic kidney disease, PCI: percutaneous coronary intervention, BMS: bare metal stent, PES: paclitaxel-eluting stent, SES: sirolimus-eluting stent, ZES: zotarolimus-eluting stent, EES: everolimus-eluting stent.

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