Impact of significant chronic kidney disease on long-term clinical outcomes after drug-eluting stent versus bare metal stent implantation

Background Higher rates of clinical and angiographic restenosis have been reported after coronary stenting in patients with significant chronic kidney disease (CKD). Whether drug-eluting stents (DES) can reduce long-term clinical events in CKD patients compared with bare metal stents (BMS) has not been established. Methods The study enrolled 104 consecutive significant CKD patients (estimated creatinine clearance < 60 ml/min) treated with DES for 142 de novo coronary lesions, comprising 76 patients treated with sirolimus-eluting stents (SES) for 106 lesions and 28 patients treated with paclitaxel-eluting stents (PES) for 36 lesions. Data from these patients were compared to those from a control group comprising 50 patients treated with BMS during the preceding 1 year. Results There were no differences in terms of baseline clinical characteristics except that the patients of the DES group were older, had a higher ratio of insulin treatment for diabetes mellitus, and had a more frequent history of previous percutaneous coronary intervention. The patients in the DES group had more unfavorable lesion characteristics with smaller reference vessel diameter (2.8 mm versus 3.3 mm; P < 0.001) and longer lesion length (28.8 mm versus 20.5 mm; P < 0.001) than those in the BMS group. Compared to BMS, DES implantation had a lower 1-year major adverse cardiac events rate (cardiac death, non-fatal myocardial infarction or target vessel revascularization) (12% versus 26%; P = 0.042). There were no significant differences between the SES and PES groups in terms of clinical outcomes. Conclusions DES implantation for de novo coronary lesions in significant CKD patients reduces 1-year clinical events compared with BMS implantation.