ialysis patients show a complex morphology of coronary artery lesions, especially marked calcification, 1 and are at higher risk for target lesion revascularization (TLR) after coronary stenting than nondialysis patients. 2 Utilization of stenting and debulking techniques reportedly improves immediate and long-term outcomes after percutaneous coronary intervention (PCI) in patients with calcified and complex lesions. [2][3][4] Recently, the use of a sirolimus-eluting stent (SES; Cypher, Cordis, Johnson & Johnson, Miami Lakes, FL, USA) has been associated with a low restenosis rate 5,6 compared with bare-metal stents (BMS) in patients with de novo native coronary lesions of intermediate (10-30 mm) length. However, the efficacy of SES for calcified and complex lesions, such as those in dialysis patients, has not been confirmed. Moreover, when patients with heavily calcified lesions undergo coronary stenting, incomplete stent expansion may occur, leading to a risk of drug-eluting stent (DES) restenosis and thrombosis. 7 In a recent report, renal failure was identified as a predictor of thrombotic events after treatment with DES. 8 Little information about the safety and efficacy of SES for the treatment of coronary artery lesions in dialysis patients is available. The present study was undertaken to assess the intermediate-term outcomes of PCI using SES in dialysis patients.
Methods
Patient PopulationAmong consecutive patients who had undergone PCI with SES between August 2004 and September 2006, we identified an index cohort of 89 patients who had been on chronic dialysis before PCI in Tsuchiya General Hospital (Hiroshima, Japan). If a patient had a second or further PCI after the index PCI, only the first PCI was included in the creation of the index PCI cohort. Patients undergoing PCI for in-stent restenosis and patients with acute myocardial infarction (MI) were excluded. After exclusion of 6 patients with in-stent restenosis and 3 patients with acute MI, the remaining 80 patients treated with SES were compared with the historical group of consecutive 124 patients treated with BMS from April 2000 to July 2004. Patients treated with BMS diameter ≥4 mm or ≤2.25 mm were excluded because the equivalent sizes of SES were not approved in Japan. From August 2004 to September 2006, 12 dialysis patients were treated with BMS: 2 patients with anticipated major surgery, 2 patients with lesions in large vessels with no appropriate SES size available, 2 patients with acute MI, 2 patients who refused the treatment, and 4 patients in whom it was anticipated there would be difficulty in delivering the SES.We compared the 1-year clinical outcomes of patients treated with SES and BMS. Most subjects were residents of Hiroshima Prefecture, a genetically representative cohort of the Japanese population. The etiologies of renal failure in Cardiology, Akane-kai, Tsuchiya General Hospital, Hiroshima, Japan Mailing address: Mamoru Toyofuku, MD, Department of Cardiology, Akane-kai, Tsuchiya General Hospital, 3-30 Nakashima-cho, Nak...
