Korean Circ J.  2006 Jun;36(6):424-430. 10.4070/kcj.2006.36.6.424.

Clinical Outcomes Following Sirolimus-Eluting Stent Implantation in Patients with End-Stage Renal Disease: Korean Multicenter Angioplasty Team (KOMATE) Registry

• Kim BK
• Oh S
• Jeon DW
• Choi D
• Jang Y
• Kwon HM
• Jung JH
• Kwon K
• Yang JY

• KMID: 2227108
• DOI: http://doi.org/10.4070/kcj.2006.36.6.424

Abstract

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stents (SES), as opposed to bare metal stents (BMS), have been shown to markedly reduce restenosis. However, many clinical trials have excluded the subset of patients (pts) with end-stage renal disease (ESRD). The aim of this study was to evaluate the clinical outcomes following SES implantation in ESRD pts.
SUBJECTS AND METHODS
We analyzed the clinical outcomes in 50 pts from our registry following SES implantation, and compared the outcomes between those with ESRD receiving SES (SES-ESRD) and BMS (BMS-ESRD), and with non-ESRD pts following SES implantation (SES-non ESRD).
RESULTS
A comparison of the SES-ESRD (50 pts, 72 lesions) with BMS-ESRD groups (42 pts, 45 lesions); those in the SES-ESRD group included; diabetes 78%, hypertension 94% and age 62+/-10 years. Those in the SES-ESRD group were more likely to have diabetes (diabetes of BMS-ESRD, 57%; p=0.04). The reference vessel diameters (RVD) of the SES-ESRD group were smaller (2.76+/-0.50 mm vs. 3.05+/-0.46 mm, p<0.001), but the lesion length was longer (25.6+/-7.0 mm vs. 19.1+/-8.8 mm, p<0.001) than those of the BMS-ESRD group. The SES-ESRD group had a lower 1-year major adverse cardiac events (MACE) rate than the BMS-ESRD group (6.0% vs. 33.3%; p<0.001). There were no differences in mortality and incidence of myocardial infarction between the two groups. The incidence of target vessel revascularization decreased significantly in the SES-ESRD group (2.0% vs. 19.0%, p=0.01). From a multivariate regression analysis, the use of SES was the only significant independent predictor of MACE (OR=0.054, 95% confidence interval 0.01 to 0.26, p<0.001). A comparison with SES-non ESRD group in our total registry (644 pts, 758 lesions); MACE in the SES-ESRD group (6.0%) was higher than in the SES-non ESRD group (3.1%), but there was no statistical significance (p=0.23).
CONCLUSION
Compared with BMS, SES caused an improvement in the clinical outcomes in pts with ESRD.

Keyword

End-stage renal disease; Stent; Coronary arterial disease

MeSH Terms

Angioplasty*
Humans
Hypertension
Incidence
Kidney Failure, Chronic*
Mortality
Myocardial Infarction
Stents*