Randomized Prospective Comparison of Everolimus-Eluting vs. Sirolimus-Eluting Stents in Patients Undergoing Percutaneous Coronary Intervention　― 3-Year Clinical Outcomes of the EXCELLENT Randomized Trial ―

Abstract

advantages in safety compared with first-generation DES. 6- 8 We previously reported the 1-year outcome of the Efficacy of Xience/promus vs. Cypher in rEducing Late Loss after stenting (EXCELLENT) Trial, comparing SES with EES. We analyzed 9-month in-segment lumen loss as a D rug-eluting stents (DES) have revolutionized the field of percutaneous coronary intervention (PCI). 1,2 First-generation DES, however, such as paclitaxelor sirolimus-eluting stents (SES), have potential long-term problems such as delayed healing, leading to risk of very late stent thrombosis (ST). Yang-Soo Jang, MD, PhD; Hyo-Soo Kim, MD, PhDBackground: Everolimus-eluting stents (EES) have equivalent short-term angiographic and clinical outcomes to sirolimus-eluting stents (SES), but EES may be superior to SES with regard to long-term clinical safety. We report the 3-year clinical outcomes of EES and SES from the prospective EXCELLENT Randomized Trial (NCT00698607).

Effect of Chronic Kidney Disease in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

“…Moreover, enhanced blood thrombogenicity related to renal dysfunction increases risk for myocardial infarction (MI) and stent thrombosis (ST) in patients with CKD (7)(8)(9). Impaired renal function is also a common comorbidity among women undergoing PCI and may be a contributor to post-PCI risk in female patients (4,10,11). However, data on clinical outcomes associated with DES implantation in women with CKD are scarce as a result of their restricted inclusion in randomized controlled trials (RCTs).…”

Continuous glucose monitoring in an end‐stage renal disease patient with diabetes receiving hemodialysis

“…For example, ESRD patients may be prone to hyperglycemia ensuing from insulin resistance, impaired insulin secretion, and exposure to high glucose peritoneal dialysate loads, which is further exacerbated in those with underlying diabetes. Conversely, many non‐dialysis dependent (NDD) CKD patients with diabetes transitioning to ESRD may experience spontaneous resolution of hyperglycemia, normalization of glycated hemoglobin (HbA1c) levels, and cessation of anti‐diabetes medications due to frequent hypoglycemia in a phenomenon known as “burnt‐out diabetes.” 5 Indeed, hypoglycemia is a frequent occurrence in diabetic and non‐diabetic NDD‐CKD and ESRD patients due to decreased renal gluconeogenesis, impaired insulin degradation and clearance by the kidney and liver, co‐existing comorbidities (malnutrition and gastroparesis), uremic toxins, and glucose shifts during hemodialysis, 5,6 and is associated with heightened death risk in these populations 7 …”