Author + information
- Received July 22, 2015
- Revision received September 11, 2015
- Accepted October 20, 2015
- Published online March 29, 2016.
- Tara I. Chang, MD, MSa,∗ (, )
- Maria E. Montez-Rath, PhDa,
- Thomas T. Tsai, MD, MScb,c,
- Mark A. Hlatky, MDa and
- Wolfgang C. Winkelmayer, MD, MPH, ScDd
- aDepartment of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California
- bInterventional Cardiology & Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
- cColorado Cardiovascular Outcomes Research Consortium, University of Colorado, Denver, Colorado
- dDepartment of Medicine, Section of Nephrology, Baylor College of Medicine, Houston, Texas
- ↵∗Reprint requests and correspondence:
Dr. Tara I. Chang, 777 Welch Road, Suite DE, Palo Alto, California 94304.
Background In patients undergoing percutaneous coronary intervention (PCI), drug-eluting stents (DES) reduce repeat revascularizations compared with bare-metal stents (BMS), but their effects on death and myocardial infarction (MI) are mixed. Few studies have focused on patients with end-stage renal disease.
Objectives This study compared mortality and cardiovascular morbidity during percutaneous coronary intervention with DES and with BMS in dialysis patients.
Methods We identified 36,117 dialysis patients from the USRDS (United States Renal Data System) who had coronary stenting in the United States between April 23, 2003, and December 31, 2010, and examined the association of DES versus BMS with 1-year outcomes: death; death or MI; and death, MI, or repeat revascularization. We also conducted a temporal analysis by dividing the study period into 3 DES eras: Transitional (April 23, 2003, to June 30, 2004); Liberal (July 1, 2004, to December 31, 2006); and Selective (January 1, 2007, to December 31, 2010).
Results One-year event rates were high, with 38 deaths; 55 death or MI events; and 71 death, MI, or repeat revascularization events per 100 person-years. DES, compared with BMS, were associated with a significant 18% lower risk of death; 16% lower risk of death or MI; and 13% lower risk of death, MI, or repeat revascularization. DES use varied, from 56% in the Transitional era to 85% in the Liberal era and 62% in the Selective era. DES outcomes in the Liberal era were significantly better than in the Transitional Era, but not significantly better than in the Selective Era.
Conclusions DES for percutaneous coronary intervention appears to be safe for use in U.S. dialysis patients and is associated with lower rates of death, MI, and repeat revascularization.
- cardiovascular disease
- end-stage renal disease
- ischemic heart disease
- renal insufficiency
This work was conducted under a data use agreement between Dr. Winkelmayer and the National Institutes of Diabetes and Digestive and Kidney Diseases. A National Institutes of Diabetes and Digestive and Kidney Diseases officer reviewed this manuscript for research compliance and approved of its submission for publication. Data reported herein were supplied by the USRDS (United States Renal Data System). Interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the U.S. government. Dr. Chang is supported by a grant from the National Institutes of Diabetes and Digestive and Kidney Diseases (K23DK095914). Dr. Winkelmayer is a scientific advisor to Amgen, Relypsa, Bayer, and Vifor Fresenius Medical Care Renal Pharma; and serves on trial committees for Bristol-Myers Squibb, Medtronic, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Anthony Bavry, MD, MPH, served as Guest Editor for this paper.
- Received July 22, 2015.
- Revision received September 11, 2015.
- Accepted October 20, 2015.
- 2016 American College of Cardiology Foundation