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Patients with vs without chronic kidney disease were found to have more comorbidities and complex lesions after receiving new-generation drug-eluting stents, according to a study published in Clinical Research Cardiology.
This study was an analysis of the results of e-Ultimaster, a prospective single-arm multicenter international registry containing information on patients who received an Ultimaster drug-eluting stent in one of 376 sites worldwide. A total of 19,475 individuals were enrolled between October 2014 and November 2016. Study participants completed a 1-year follow-up by November 30, 2016. In this cohort, 1466 patients had chronic kidney disease, including 167 on hemodialysis. The study’s primary end points were target lesion failure or target revascularization at 1 year.
Patients with impaired vs normal renal function were found to be more likely to present with comorbidities, including hypertension (83.9% vs 62.2%, respectively; P <.0001), diabetes (48.9% vs 26.5%, respectively; P <.0001), hypercholesterolemia (66.7% vs 55.9%, respectively; P <.0001), and percutaneous coronary intervention (34% vs 24.9%, respectively; P <.0001).
Patients with vs without chronic kidney disease were also found to be more likely to present with a higher number of diseased vessels (1.83±0.8 vs 1.62±0.8, respectively; P <.0001) and more vessels that were ≤2.75 mm (49.2% vs 43.9%, respectively; P =.0001). They were also more likely to experience adverse events, including cardiac death (5.1% vs 1.1%, respectively; P <.0001) and target lesion failure (7.5% vs 3.0%, respectively; P <.0001).
Patients with chronic kidney disease who were also on hemodialysis were significantly more likely to present with diabetes (63.5% vs 46.9%, respectively; P <.0001) and experience more all-cause death (16.2% vs 7.3%, respectively; P =.0005) than patients with impaired renal function who were not undergoing hemodialysis. Patients with chronic kidney disease had slightly lower rates of definite stent thrombosis than those without impaired renal function (0.3% vs 0.4%, respectively).
Study limitations include the use of nonstandardized follow-up procedures that may have affected the reporting of adverse events, the lack of reporting of medication adherence, and biological heterogeneity and patient characteristics such as age and comorbidities which could have confounded the results.
“In this large cohort of all-comer patients undergoing new-generation [drug-eluting stents] implantation, CKD and in particular [hemodialysis] were associated with a higher risk of adverse events including [target lesion failure] when compared with the reference population,” concluded the study authors. “Although higher rates of adverse events were observed, low stent thrombosis rates indicate good performance in this high-risk patient population.”
Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please refer to reference for a complete list of authors’ disclosures.
Reference
Scholz SS, Lauder L, Ewen S, et al. One-year clinical outcomes in patients with renal insufficiency after contemporary PCI: data from a multicenter registry [published online December 2, 2019]. Clin Res Cardiol. doi: 10.1007/s00392-019-01575-y
