Korean J Intern Med.
2012 Dec;27(4):397-406.
Comparison of Drug-Eluting Stents in Acute Myocardial Infarction Patients with Chronic Kidney Disease
- Hachinohe
- Jeong MH
- Saito S
- Kim MC
- Cho KH
- Ahmed K
- Hwang SH
- Lee MG
- Sim DS
- Park KH
- Kim JH
- Hong YJ
- Ahn Y
- Kang JC
- Kim JH
- Chae SC
- Kim YJ
- Hur SH
- Seong IW
- Hong TJ
- Choi D
- Cho MC
- Kim CJ
- Seung KB
- Chung WS
- Jang YS
- Rha SW
- Bae JH
- Park SJ
- Korea Acute Myocardial Infarction Registry Investigators
- Affiliations
-
- 1Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea. myungho@chollian.net
- 2Department of Internal Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
- 3Department of Internal Medicine, Pusan Hanseo Hospital, Busan, Korea.
- 4Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
- 5Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
- 6Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
- 7Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
- 8Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
- 9Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
- 10Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
- 11Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea.
- 12Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
- 13Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
- 14Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea.
- 15Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Abstract
- BACKGROUND/AIMS
To determine which drug-eluting stents are more effective in acute myocardial infarction (MI) patients with chronic kidney disease (CKD).
METHODS
This study included a total of 3,566 acute MI survivors with CKD from the Korea Acute Myocardial Infarction Registry who were treated with stenting and followed up for 12 months: 1,845 patients who received sirolimus-eluting stents (SES), 1,356 who received paclitaxel-eluting stents (PES), and 365 who received zotarolimus-eluting stents (ZES). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 calculated by the modification of diet in renal disease method.
RESULTS
At the 12-month follow-up, patients receiving ZES demonstrated a higher incidence (14.8%) of major adverse cardiac events (MACEs) compared to those receiving SES (10.1%) and PES (12%, p = 0.019). The ZES patients also had a higher incidence (3.9%) of target lesion revascularization (TLR) compared to those receiving SES (1.5%) and PES (2.4%, p = 0.011). After adjusting for confounding factors, ZES was associated with a higher incidence of MACE and TLR than SES (adjusted hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.442 to 0.879; p = 0.007; adjusted HR, 0.350; 95% CI, 0.165 to 0.743; p = 0.006, respectively), and with a higher rate of TLR than PES (adjusted HR, 0.471; 95% CI, 0.223 to 0.997; p = 0.049).
CONCLUSIONS
Our findings suggest that ZES is less effective than SES and PES in terms of 12-month TLR, and has a higher incidence of MACE due to a higher TLR rate compared with SES, in acute MI patients with CKD.
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