Stent selection among patients with chronic kidney disease: Results from the NCDR CathPCI Registry

Abstract

Objectives: This study sought to define contemporary rates of drug eluting stent (DES) usage in patients with chronic kidney disease (CKD). Background: Among patients with CKD undergoing percutaneous coronary interventions (PCIs), outcomes are superior for those who receive DES compared to those who receive bare metal stents (BMSs). However, perceived barriers may limit the use of DES in this population. Methods: All adult PCI cases from the NCDR CathPCI Registry involving coronary stent placement between July 1, 2009 and December 31, 2015 were analyzed. The rate of DES usage was then compared among four groups, stratified by CKD stage (I/II, III, IV, and V). Subgroup analysis was conducted based on PCI status and indication. Cases were linked to Medicare claims data to assess 1-year mortality. Results: A total of 3,650,333 PCI cases met criteria for analysis. DES usage significantly declined as renal function worsened (83.0%, 79.9%, 75.6%, and 75.6%, respectively, in the four CKD stages; p < .001). DES usage was universally lower across the four groups in the setting of ST-Elevation Myocardial Infarction (STEMI) (70.6%, 66.5%, 58.7%, 58.0%; p < .001) and higher in the setting of elective PCI (87.6%, 84.9%, 82.3%, 77.9%; p < .0001). DES was associated with improved 1-year survival, and usage increased over time across each group. Conclusions: DESs are underutilized in patients with advanced renal dysfunction. Although DES usage has increased over time, variation still exists between patients with normal renal function and those with CKD. K E Y W O R D S bare metal stents, chronic kidney disease, drug-eluting stents 1 | INTRODUCTION Management of ischemic heart disease in patients with chronic kidney disease (CKD) is challenging because the prevalence of coronary artery disease is high in this population, and the associated coronary lesions are often complex. 1,2 Outcomes following percutaneous coronary interventions (PCIs) are poorer among patients with CKD than those with normal renal function, and the risk of adverse outcomes appears to progressively increase as renal function declines. 3-5 Limited data suggest that PCI outcomes among CKD patients across all stages are more favorable among those who receive drug-eluting stents (DESs) compared to those who receive bare metal stents

Digital variance angiography in patients undergoing lower limb arterial recanalization: cost–effectiveness analysis within the English healthcare setting

“…The proportion of CKD patients with CKD stages 3–4 and stage 5 was informed by information from Feldman et al [ 23 ], which assessed the rates of drug eluting stent (DES) usage in patients with CKD between 2009 and 2015. The transition probabilities for patients experiencing CA-AKI to the latter stage health states, as well as for patients with stage 3–4 CKD progressing to stage 5 at different age categories, were sourced from prior literature [ 24–26 ].…”