Impact of chronic renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary intervention with sirolimus-eluting stents versus bare metal stents

Pramod K. Kuchulakanti, Rebecca Torguson, William W. Chu, Daniel A. Canos, Seung-Woon Rha, Leonardo Clavijo, Regina Deible, Natalie Gevorkian, William O. Suddath, Lowell F. Satler, Kenneth M. Kent, Augusto D. Pichard, Ron Waksman

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Abstract

Patients with chronic renal insufficiency (CRI) have higher rates of target vessel revascularization and mortality. The efficacy of sirolimus-eluting stents (SESs) to improve the clinical outcomes of these patients is unknown. We investigated the effect of SESs versus bare metal stents (BMSs) on outcomes of patients with CRI. Among the first 1,522 patients treated with SESs, 76 were identified with CRI and 1,446 without CRI. In-hospital and 1- and 6-month clinical outcomes were compared with 153 patients with CRI who were treated with BMSs. Patients with CRI were older, hypertensive, and diabetic and had more previous myocardial infarctions, revascularizations, and decreased left ventricular function (p <0.001). These patients had more saphenous vein graft lesions, were treated with more debulking devices (p <0.003), and had higher rates of in-hospital complications and mortality (p <0.001) compared with those without CRI. Among patients with CRI, treatment with SESs did not affect clinical outcomes at 1 month and was associated with lower incidences of target vessel revascularization (7.1% vs 22.1%, p = 0.02) at 6 months but did not affect other events, including mortality (16.7% vs 14.7% p = 0.89), compared with BMSs. However, treatment with SESs in patients without CRI was associated with significantly lower rates of major adverse cardiac events at 6 months (p <0.001). In conclusion, percutaneous coronary intervention with SESs in patients with CRI is associated with low rates of repeat revascularization compared with BMSs but has no effect on mortality at 6 months.

Original languageEnglish
Pages (from-to)792-797
Number of pages6
JournalAmerican Journal of Cardiology
Volume97
Issue number6
DOIs
Publication statusPublished - 2006 Mar 15
Externally publishedYes

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Sirolimus
Percutaneous Coronary Intervention
Chronic Renal Insufficiency
Stents
Metals
Mortality
Myocardial Revascularization
Saphenous Vein
Hospital Mortality
Left Ventricular Function
Myocardial Infarction
Transplants
Equipment and Supplies
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of chronic renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary intervention with sirolimus-eluting stents versus bare metal stents. / Kuchulakanti, Pramod K.; Torguson, Rebecca; Chu, William W.; Canos, Daniel A.; Rha, Seung-Woon; Clavijo, Leonardo; Deible, Regina; Gevorkian, Natalie; Suddath, William O.; Satler, Lowell F.; Kent, Kenneth M.; Pichard, Augusto D.; Waksman, Ron.

In: American Journal of Cardiology, Vol. 97, No. 6, 15.03.2006, p. 792-797.

Research output: Contribution to journalArticle

Kuchulakanti, PK, Torguson, R, Chu, WW, Canos, DA, Rha, S-W, Clavijo, L, Deible, R, Gevorkian, N, Suddath, WO, Satler, LF, Kent, KM, Pichard, AD & Waksman, R 2006, 'Impact of chronic renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary intervention with sirolimus-eluting stents versus bare metal stents', American Journal of Cardiology, vol. 97, no. 6, pp. 792-797. https://doi.org/10.1016/j.amjcard.2005.10.018
Kuchulakanti, Pramod K. ; Torguson, Rebecca ; Chu, William W. ; Canos, Daniel A. ; Rha, Seung-Woon ; Clavijo, Leonardo ; Deible, Regina ; Gevorkian, Natalie ; Suddath, William O. ; Satler, Lowell F. ; Kent, Kenneth M. ; Pichard, Augusto D. ; Waksman, Ron. / Impact of chronic renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary intervention with sirolimus-eluting stents versus bare metal stents. In: American Journal of Cardiology. 2006 ; Vol. 97, No. 6. pp. 792-797.
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abstract = "Patients with chronic renal insufficiency (CRI) have higher rates of target vessel revascularization and mortality. The efficacy of sirolimus-eluting stents (SESs) to improve the clinical outcomes of these patients is unknown. We investigated the effect of SESs versus bare metal stents (BMSs) on outcomes of patients with CRI. Among the first 1,522 patients treated with SESs, 76 were identified with CRI and 1,446 without CRI. In-hospital and 1- and 6-month clinical outcomes were compared with 153 patients with CRI who were treated with BMSs. Patients with CRI were older, hypertensive, and diabetic and had more previous myocardial infarctions, revascularizations, and decreased left ventricular function (p <0.001). These patients had more saphenous vein graft lesions, were treated with more debulking devices (p <0.003), and had higher rates of in-hospital complications and mortality (p <0.001) compared with those without CRI. Among patients with CRI, treatment with SESs did not affect clinical outcomes at 1 month and was associated with lower incidences of target vessel revascularization (7.1{\%} vs 22.1{\%}, p = 0.02) at 6 months but did not affect other events, including mortality (16.7{\%} vs 14.7{\%} p = 0.89), compared with BMSs. However, treatment with SESs in patients without CRI was associated with significantly lower rates of major adverse cardiac events at 6 months (p <0.001). In conclusion, percutaneous coronary intervention with SESs in patients with CRI is associated with low rates of repeat revascularization compared with BMSs but has no effect on mortality at 6 months.",
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AU - Torguson, Rebecca

AU - Chu, William W.

AU - Canos, Daniel A.

AU - Rha, Seung-Woon

AU - Clavijo, Leonardo

AU - Deible, Regina

AU - Gevorkian, Natalie

AU - Suddath, William O.

AU - Satler, Lowell F.

AU - Kent, Kenneth M.

AU - Pichard, Augusto D.

AU - Waksman, Ron

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N2 - Patients with chronic renal insufficiency (CRI) have higher rates of target vessel revascularization and mortality. The efficacy of sirolimus-eluting stents (SESs) to improve the clinical outcomes of these patients is unknown. We investigated the effect of SESs versus bare metal stents (BMSs) on outcomes of patients with CRI. Among the first 1,522 patients treated with SESs, 76 were identified with CRI and 1,446 without CRI. In-hospital and 1- and 6-month clinical outcomes were compared with 153 patients with CRI who were treated with BMSs. Patients with CRI were older, hypertensive, and diabetic and had more previous myocardial infarctions, revascularizations, and decreased left ventricular function (p <0.001). These patients had more saphenous vein graft lesions, were treated with more debulking devices (p <0.003), and had higher rates of in-hospital complications and mortality (p <0.001) compared with those without CRI. Among patients with CRI, treatment with SESs did not affect clinical outcomes at 1 month and was associated with lower incidences of target vessel revascularization (7.1% vs 22.1%, p = 0.02) at 6 months but did not affect other events, including mortality (16.7% vs 14.7% p = 0.89), compared with BMSs. However, treatment with SESs in patients without CRI was associated with significantly lower rates of major adverse cardiac events at 6 months (p <0.001). In conclusion, percutaneous coronary intervention with SESs in patients with CRI is associated with low rates of repeat revascularization compared with BMSs but has no effect on mortality at 6 months.

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