Drug-eluting stents (DES) appear to be safe for use in patients with end-stage renal disease, according to research published in the Journal of the American College of Cardiology.
Few studies have previously focused on this patient population. Therefore, researchers chose to identify more than 36 000 patients on dialysis from the United States Renal Data System who had coronary stenting between April 2003 and December 2010. They sought to compare mortality and cardiovascular morbidity during percutaneous coronary intervention (PCI) using DES vs bare-metal stents (BMS).
Three outcomes were measured within 1 year after index PCI: death from any cause; death or myocardial infarction (MI); and death, MI, or repeat revascularization. All patients were at least 18 years of age (mean age: 64 years), had end-stage renal disease, and underwent PCI with stenting after the first DES was approved by the US Food and Drug Administration on April 24, 2003.
Covariate data included age, sex, race, Hispanic ethnicity, dialysis modality (hemodialysis or peritoneal), and presumed cause of end-stage renal disease. There was a high prevalence of comorbidities including, diabetes, hypertension, and hyperlipidemia. Among patients who received a DES, there was a higher prevalence of diabetes, but among those who received a BMS, there was more often a previous history of MI and MI with ST-segment elevation.
The presence of heart failure and diabetes, along with female sex and multivessel intervention, were associated with higher odds of receiving a BMS vs a DES. At 1 year, there were 38 deaths from any cause; 55 deaths or MI events; and 71 deaths, MIs, or repeat revascularization events per 100 person-years. DES patients had lower unadjusted rates of death; death or MI; and death, MI, or repeat revascularization compared with BMS patients.
DES was associated with an 18% hazard ratio (HR; 95% confidence interval [CI]: 14%-22%) lower risk of death; 16% HR (95% CI: 13%-19%) lower risk of death or MI; and 13% HR (95% CI: 9%-16%) lower risk of death, MI, or repeat revascularization.
“The use of DES in patients with ESRD [end-stage renal disease] on dialysis mirrored trends in the general population: rapidly increasing after its introduction to the US market in mid-2003, decreasing in 2006 over concerns regarding higher risks of stent thrombosis, and stabilizing from 2006 onward,” researchers noted.
They concluded, “Until a randomized clinical trial is conducted, our study provides additional evidence to support current guidelines recommending preferential use of DES over BMS in this high-risk patient population.”
Future studies should include patients with diverse kidney function, including those with end-stage renal disease on dialysis.
Chang TI, Montez-Rath ME, Tsai TT, Hlatky MA, Winkelmayer WC. Drug-eluting vs bare-metal stents during PCI in patients with end-stage renal disease on dialysis. J Am Coll Cardiol. 2016;67(12):1459-1469. doi: 10.1016/j.jacc.2015.10.104.