Coronary Stents in Patients with ST-Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention.
10.4070/kcj.2012.42.12.830
- Author:
Khurshid AHMED
1
;
Myung Ho JEONG
;
Rabin CHAKRABORTY
;
Sumera AHMED
;
Young Joon HONG
;
Doo Sun SIM
;
Keun Ho PARK
;
Ju Han KIM
;
Youngkeun AHN
;
Jung Chaee KANG
;
Myeong Chan CHO
;
Chong Jin KIM
;
Young Jo KIM
Author Information
1. The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea. myungho@chollian.net
- Publication Type:Original Article
- Keywords:
Myocardial infarction;
Stents;
Angioplasty;
Kidney failure, chronic
- MeSH:
Angioplasty;
Glomerular Filtration Rate;
Glycosaminoglycans;
Humans;
Incidence;
Kaplan-Meier Estimate;
Kidney Failure, Chronic;
Myocardial Infarction;
Percutaneous Coronary Intervention;
Renal Insufficiency, Chronic;
Stents
- From:Korean Circulation Journal
2012;42(12):830-838
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). We sought to compare different coronary stents used during primary PCI in patients with ST-elevation myocardial infarction (STEMI) and CKD. SUBJECTS AND METHODS: We selected 2408 consecutive STEMI patients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) undergoing primary PCI and divided them into 5 groups based on the type of stent implanted: 1) bare metal stent (BMS), 2) paclitaxel-eluting stent (PES), 3) sirolimus-eluting stent (SES), 4) zotarolimus-eluting stent (ZES), or 5) everolimus-eluting stent (EES). The study endpoint was the number of major adverse cardiac events (MACE) at 12 months. RESULTS: There was no significant difference in the incidence of 12-month myocardial infarction, target lesion revascularization, or target vessel revascularization between stent groups; however, the overall rate of repeat revascularization differed significantly between groups. All-cause death differed significantly among the groups. The incidence of 12-month MACE in BMS, PES, SES, ZES, and EES was 8.3%, 9.8%, 8.6%, 5.5%, and 2.6%, respectively (p<0.001). Kaplan-Meier analysis did not show a significant differences in 12-month MACE-free survival among the groups (log-rank p=0.076). This finding remained the same after adjusting for multiple confounders (p=0.147). CONCLUSION: Any of the 5 stents can be used to treat STEMI patients with CKD undergoing primary PCI; all have similar risk of 12-month MACE. This result is hypothesis-generating and warrants further evaluation with a long-term randomized study.
