Author + information
- Received November 10, 2010
- Revision received June 21, 2011
- Accepted June 28, 2011
- Published online October 25, 2011.
- Thomas T. Tsai, MD, MSc⁎,†,⁎ (, )
- John C. Messenger, MD†,
- J. Matthew Brennan, MD‡,
- Uptal D. Patel, MD‡,
- David Dai, PhD‡,
- Robert N. Piana, MD§,
- Kevin J. Anstrom, PhD‡,
- Eric L. Eisenstein, DBA‡,
- Rachel S. Dokholyan, MPH‡,
- Eric D. Peterson, MD, MPH‡ and
- Pamela S. Douglas, MD‡
- ↵⁎Reprint requests and correspondence:
Dr. Thomas T. Tsai, Denver VA Medical Center, Cardiology Section 111B, 1055 Clermont Street, Denver, Colorado 80220
Objectives The purpose of this study was to determine the safety and efficacy of drug-eluting stents (DES) compared with bare-metal stents (BMS) in older patients with chronic kidney disease (CKD).
Background DES may be associated with late death and myocardial infarction (MI) secondary to stent thrombosis. However, data on outcomes in older patients with CKD are limited.
Methods We estimated the glomerular filtration rate (GFR) of 283,593 patients 65 years of age and older who underwent stent implantation between 2004 and 2007. In propensity-matched cohorts grouped by GFR, the association between DES and BMS and the risk of death, MI, revascularization, and major bleeding was examined.
Results A total of 121,446 patients (42.8%) had CKD (GFR <60 ml/min/1.73 m2). The 30-month mortality rate for patients on long-term dialysis was 52.0%. In propensity-matched pairs, placement of a DES compared with a BMS in patients with normal renal function was associated with significant reductions in 30-month revascularization (hazard ratio [HR]: 0.91; 95% confidence interval [CI]: 0.86 to 0.95), MI (HR: 0.77; 95% CI: 0.71 to 0.83), and death (HR: 0.73; 95% CI: 0.69 to 0.77), but no difference in bleeding (HR: 0.89; 95% CI: 0.79 to 1.00). Lower MI and mortality rates were also observed after DES compared with BMS implantation in all CKD subgroups with the exception of MI in the long-term dialysis group. Decreased rates of revascularization did not extend to any subgroup of patients with CKD.
Conclusions The safety of DES compared with BMS is observed in all patients regardless of renal function and is associated with reduced rates of MI and death in some subsets of patients with CKD.
This project was funded under contract no. HHSA29020050032I Task Order No. 4 from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. Dr. Eisenstein has received grant support from Medtronic Cardiovascular and Eli Lilly & Co. Dr. Peterson has received research support from Bristol-Myers Squibb/Sanofi, Merck, Lilly, and Johnson & Johnson. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 10, 2010.
- Revision received June 21, 2011.
- Accepted June 28, 2011.
- American College of Cardiology Foundation