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The outcomes of the first-generation drug-eluting stent were disappointing in patients with chronic kidney disease (CKD), especially hemodialysis (HD). Currently, new-generation, bioresorbable polymer-everolimus eluting stent (BP-EES) is available in the real word. The present study is to compare the outcome of BP-EES with EES and platinum chromium-EES (PtCr-EES) in CKD patients.
Of 2223 percutaneous coronary intervention (PCI) treated with BP-EES, EES and PtCr-EES from January 2012 to May 2016 at two centers, 152 stents [BP-EES (n=51), EES (n=54), PtCr-EES (n=47)] were implanted in 122 patients with CKD, followed by coronary angiography at 12-month after initial PCI. CKD was defined as eGFR<30 ml/min/1.73m2 including HD. Target lesion revascularization (TLR), non target lesion-target vessel revascularization (non TL-TVR), stent thrombosis (ST) and major adverse cardiac event (MACE) were evaluated. The definition of MACE was cardiovascular death, myocardial infarction, repeat PCI and coronary artery bypass graft surgery. The parameters such as minimum lumen diameter (MLD) and late loss were measured using quantitative coronary angiography (QCA).
No ST was observed. Among 3 stent groups, there were no differences in patient’s characteristics such as the morbidity of HD and diabetes mellitus. There were also no differences in lesion characteristics including QCA parameter, the severity of calcification, ACC/AHA classification and PCI procedure such as the size of the implanted stent. Significant differences were not observed in MLD and %stenosis diameter immediately after PCI (BP-EES 2.57±0.21 vs. EES 2.80±0.31 vs. PtCr-EES 2.76±0.33mm, p=0.22; 11.2±10.5 vs.7.8±6.7 vs. 9.5±10.7%, p=0.32, respectively). At follow-up, there were any differences in MACE and TLR (BP-EES 29.1% vs. EES 15.4% vs. PtCr-EES 14.2%, P=0.06; BP-EES 25.4 vs. EES 11.1 vs. PtCr-EES 10.6%, P=0.07). Late loss in BP-EES was significantly greater than EES and PtCr-EES (0.55±0.64 vs. 0.25±0.70 vs. 0.20±0.61mm, p=0.03).
BP-EES might tend to cause in-stent restenosis due to greater late loss in patients with the end-stage of CKD including HD compared with EES and PtCr-EES.
CORONARY: PCI Outcomes