SWEDEHEART-1-year data show no benefit of newer generation drug-eluting stents over bare-metal stents in patients with severe kidney dysfunction following percutaneous coronary intervention. Issue 1 (January 2020)

• Record Type: Journal Article
• Authors: Edfors, Robert; James, Stefan; Szummer, Karolina; Evans, Marie; Carrero, Juan-Jesus; Faxén, Jonas; Persson, Jonas; Spaak, Jonas; Varenhorst, Christoph; Jernberg, Tomas; Lagerqvist, Bo
• Is Part Of: Coronary artery disease. Volume 31:Issue 1(2020:Jan.)
• Publication Date: 2020-01
• Subjects: chronic kidney disease -- coronary angiography -- coronary artery stenting -- renal dysfunction -- stent restenosis -- stent thrombosis; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000000814
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Background: We hypothesized that the transition from bare-metal stents (BMS) to newer generation drug-eluting stents (n-DES) in clinical practice may have reduced the risk also in patients with kidney dysfunction. Methods: Observational study in the national SWEDEHEART registry, that compared the 1-year risk of in-stent restenosis (RS) and stent thrombosis (ST) in all percutaneous coronary intervention treated patients(n = 92 994) during 2007–2013. Results: N-DES patients were younger than BMS, but had more often diabetes, previous myocardial infarction, previous revascularization and were more often treated with potent platelet inhibition. N-DES versus BMS, was associated with lower 1-year risk of RS in patients with estimated glomerular filtration rate (eGFR) >60 with a cumulative probability of 2.1% versus 5.3%, adjusted hazard ratio 0.30, 95% CI (0.27–0.34) and with eGFR 30–60: 3.0% versus 4.9%; hazard ratio 0.46 (0.36–0.60) but not in patients with eGFR <30: 8.1% versus 6.0%; hazard ratio 1.32 (0.71–2.45) (pinteraction = 0.009) as well as lower risk of ST for eGFR >60 and eGFR 30–60: 0.5% versus 0.9%; hazard ratio 0.52 (0.40–0.68) and 0.6% versus 1.3%; hazard ratio 0.54 (0.54–0.72) but not for eGFR <30; 2.1% versus 1.1%; hazard ratio 1.49 (0.56–3.98) (pinteraction = 0.027). Conclusion: N-DES is associated with lower 1-year risk of in-stent restenosis and stent thrombosis in patients with normal or moderately reduced kidney function but not in patients with severe kidney dysfunction, where stenting is associated with worse outcomes regardless of stent type. Abstract : Supplemental Digital Content is available in the text.