Comparison of Long-Term Clinical Outcome After Sirolimus-Eluting Stent Implantation in Patients With and Without Hemodialysis

Abstract

SUMMARYPoor clinical outcomes for hemodialysis (HD) patients compared to non-HD patients after coronary intervention have been reported. Although coronary intervention using sirolimus-eluting stents (SESs) might be expected to reduce restenosis in HD patients, little is known about the efficacy of the SESs. The purpose of the present study was to compare the clinical and angiographic outcomes of HD patients with non-HD patients after SES implantation. The study population consisted of 170 consecutive patients (234 lesions) who had undergone successful coronary SES implantation. The patients were classified into 2 groups, an HD group (18 patients, 27 lesions) and a non-HD group (152 patients, 207 lesions). The incidence of any clinical event was significantly higher in the HD group than in the non-HD group (50.0% versus 12.5%, P < 0.0001). Target lesion revascularization was necessary in 6 patients (33.3%) in the HD group and in 7 patients (4.6%) in the non-HD group (P < 0.0001). The Cox proportional-hazards regression model on cardiac events identified HD patients (P = 0.0301, hazard ratio = 2.704) as an explanatory factor. Moreover, the Cox proportional-hazards regression model on target lesion revascularization identified HD (P = 0.0004, hazard ratio = 6.921) and in-stent restenosis lesion (P = 0.0293, hazard ratio = 3.323) as explanatory factors. The present study suggests that compared with non-HD patients, HD patients with coronary artery disease treated by SESs have a poorer clinical outcome. (Int Heart J 2007; 48: 689-700) Key words: Sirolimus-eluting stents, Hemodialysis, Clinical outcome HEMODIALYSIS (HD) patients are well known to be a high risk population for coronary artery disease. 1) Moreover, poor clinical outcomes compared to non-HD patients after coronary intervention have been reported. 2,3) Previous studies of sirolimus-eluting stents (SESs) compared with bare-metal stents (BMSs) in coronary artery disease have demonstrated a reduction in the incidence of cardiac events related to recurrent ischemia and lower rates of angiographic restenosis. 4-7)From the

Cardiac Survival after Pre-emptive Coronary Angiography in Transplant Patients and Those Awaiting Transplantation

“…The small but significant incidence of coronary events postintervention will require further study, which we are currently undertaking. Within the current renal literature, there are studies with small numbers of mainly symptomatic patients with restenosis rates of 22% to 33% up to 1 year after percutaneous intervention (34,35), and more historical reports of restenosis rates of 60% to 75% up to 1 year after balloon angioplasty (33,36).…”

Long-term Clinical Outcomes After Sirolimus-Eluting Stent Implantation in Dialysis Patients

“…demonstrated no significant differences in angiographic insegment restenosis (31% versus 43%, P = 0.4) and TLR rates (14% versus 21%, P = 0.3) between SES and BMS. Sasao, et al 4) reported a higher TLR rate after SES implantation in dialysis patients than in nondialysis patients (33.3% versus 4.6%, P < 0.0001). One possible explanation for the difference is a high mortality rate in non-Japanese dialysis patients.…”

“…However, the present study showed a restenosis rate similar to that in previous studies for dialysis patients, in which rotational atherectomy was used in some lesions. [3][4][5][6] Only SES was used in the present study. The results may not be applicable to other DES.…”

“…On the other hand, high adverse cardiac event rates after sirolimus-eluting stent (SES) implantation in dialysis patients have been shown, although long-term (> 1 year) clinical follow-up was not available. [3][4][5][6] It has been reported that the dominant angiographic restenosis pattern is focal in dialysis patients treated with SES and diffuse in those with BMS.…”

Impact of chronic kidney disease on clinical and angiographic results following implantation of sirolimus-eluting coronary stents

“…It is well known that drug-eluting stent(s) (DES) reduces major adverse cardiac events (MACE) and target lesion revascularization (TLR). However, hemodialysis is a strong predictor of poor outcome with DES in terms of higher mortality [3,4] and higher TLR rate [4][5][6].…”