Sirolimus-eluting stents versus paclitaxel-eluting stents for coronary intervention in patients with renal failure on hemodialysis

Abstract

Patients undergoing chronic hemodialysis (HD) are at high risk of restenosis and cardiac events after percutaneous coronary intervention (PCI). This study compared the clinical efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients undergoing HD. Between June 2004 and January 2010, the clinical outcomes of 41 consecutive patients on HD who underwent PCI with SES (62 lesions) were compared with those of 38 consecutive patients on HD who underwent PCI with PES (54 lesions). Patient and lesion characteristics were similar between both groups. The target lesion revascularization (TLR) (SES 36.6 % vs. PES 15.8 %; P = 0.037) was significantly higher with SES (36.6 %) than with PES (15.8 %) (P = 0.037), particularly in the context of severe calcified lesions that required rotational atherectomy (SES 72.7 % vs. PES 16.7 %; P = 0.0067). However, 1 year after PCI, there was no difference between the two groups in all-cause death, myocardial infarction or major adverse cardiac events. Patients undergoing HD are at a high risk of restenosis after PCI, even when using a drug-eluting stent. The TLR was higher with SES than with PES, particularly when used for severe calcified lesions that required rotational atherectomy.

Long-Term Clinical Outcome of Drug-Eluting vs. Bare-Metal Stent Implantation After Percutaneous Coronary Intervention in End-Stage Renal Disease Patients on Hemodialysis ― Nationwide Cohort Study in Taiwan ―

“…6,10, 12 The results of the observational studies, however, were heterogeneous: some showed that DES was superior to BMS, 2,8,13-15 whereas others did not. [16][17][18][19][20] The inconsistent results from the observation studies may be due to small cohort size, short-term follow-up, or lack of adequate adjustment for potential confounders. One recent meta-analysis evaluated current evidence for the efficacy and safety of DES and BMS in dialysis patients.…”

Treatment of symptomatic coronary artery disease in patients with end‐stage renal disease on hemodialysis with paclitaxel‐eluting TAXUS stent

“…In their study, they observed that patients on hemodialysis receiving TAXUS stent had a major reduction in TVR comparing with patients receiving SES (6.5% vs. 17.5% at 12 months, which is very similar to our study, 6.7%), what caused also significant reduction in MACE. Another recently published small study showed that difference in target lesion revascularization might be even higher particularly in dialysis patients with most heavily calcified lesions (SES 72.7% vs. PES 16.7%) . Although there is not enough data to make a final conclusion, it seems that paclitaxel might be able to better stabilize local inflammatory changes of target lesions in patients on hemodialysis and might be a better stent for this population.…”

“…Another recently published small study showed that difference in target lesion revascularization might be even higher particularly in dialysis patients with most heavily calcified lesions (SES 72.7% vs. PES 16.7%). 27 Although there is not enough data to make a final conclusion, it seems that paclitaxel might be able to better stabilize local inflammatory changes of target lesions in patients on hemodialysis and might be a better stent for this population.…”

Comparison of Limus-Eluting and Paclitaxel-Eluting Stents for Coronary Intervention in Patients with Chronic Kidney Disease

“…[9][10][11][12][15][16][17][23][24][25][26][27][28][29][30][31][32] Study characteristics and quality assessment: The characteristics and overall quality of the individual trials are shown in Table I. Of these 17 studies, 15 were observational retrospective studies 9,12,[15][16][17][23][24][25][26][27][28][29][30][31][32] and 2 were randomized controlled studies. 10,11) The studies varied in sample size from 68 to 3,201 patients with a follow-up period ranging from 12 months to 47 months.…”

“…Seven out of 17 studies evaluated the efficacy and safety of limus-eluting versus paclitaxel-eluting stents for patients with end-stage renal disease on dialysis. 11,16,[24][25][26]28,29) In addition, all studies included in our meta-analysis were considered as high quality (RCT with a Jadad score of ! 2 and observational studies with a Newcastle-Ottawa Quality Assessment Scale score of !6).…”