MedStar Authors catalog › Details for: Drug-eluting stents in patients on chronic hemodialysis: paclitaxel-eluting stents vs. limus-eluting stents.
Drug-eluting stents in patients on chronic hemodialysis: paclitaxel-eluting stents vs. limus-eluting stents. Journal: Cardiovascular revascularization medicine : including molecular interventions.ISSN: 1878-0938.UI/PMID: 24684759.Subject(s): Aged | *Cardiovascular Agents/ad [Administration & Dosage] | Chi-Square Distribution | Coronary Artery Disease/co [Complications] | Coronary Artery Disease/di [Diagnosis] | Coronary Artery Disease/mo [Mortality] | *Coronary Artery Disease/th [Therapy] | Coronary Restenosis/et [Etiology] | Coronary Restenosis/mo [Mortality] | Diabetes Mellitus/mo [Mortality] | District of Columbia/ep [Epidemiology] | *Drug-Eluting Stents | *Everolimus/ad [Administration & Dosage] | Female | Humans | Kaplan-Meier Estimate | Male | Middle Aged | Multivariate Analysis | Myocardial Infarction/et [Etiology] | Myocardial Infarction/mo [Mortality] | *Paclitaxel/ad [Administration & Dosage] | Percutaneous Coronary Intervention/ae [Adverse Effects] | *Percutaneous Coronary Intervention/is [Instrumentation] | Percutaneous Coronary Intervention/mo [Mortality] | Prevalence | Proportional Hazards Models | Prospective Studies | Prosthesis Design | Renal Dialysis/ae [Adverse Effects] | Renal Dialysis/mo [Mortality] | *Renal Dialysis | Renal Insufficiency, Chronic/co [Complications] | Renal Insufficiency, Chronic/di [Diagnosis] | Renal Insufficiency, Chronic/mo [Mortality] | *Renal Insufficiency, Chronic/th [Therapy] | Risk Factors | Time Factors | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Comparative Study | Journal ArticleDigital Object Identifier: http://dx.doi.org/10.1016/j.carrev.2014.01.006 (Click here) Abbreviated citation: Cardiovasc Revasc Med. 15(2):86-91, 2014 Mar.Local Holdings: Available in print through MWHC library: 2002 - present.Abstract: BACKGROUND: Patients requiring chronic hemodialysis (HD) are at high risk for restenosis after percutaneous coronary intervention (PCI) with bare metal stents. Outcome data on drug-eluting stent (DES) implantation in HD patients are limited and suggest superiority of paclitaxel-eluting stents (PES) over limus-eluting stents (LES); METHODS: In total, 218 consecutive patients were prospectively enrolled. A comparison of post-PCI outcomes up to 2 years was carried out between patients receiving PES (n=62) and LES (n=156; SES n=112, EES n=44). The primary end point was 2-year major adverse cardiac events [MACE; death, Q-wave myocardial infarction and target lesion revascularization (TLR)]; RESULTS: Baseline characteristics were comparable. The overall prevalence of diabetes mellitus was 71%. On clinical follow-up to 2 years, MACE rates were similar [PES 32/51 (62.7%) vs. LES 77/132 (58.3%), p=0.59]; however, clinically-driven revascularization occurred more than twice as frequently in LES patients: TLR [PES 4/36 (11.1%) vs. LES 24/93 (25.8%), p=0.07] and target vessel revascularization [5/37 (13.5%) vs. 33/96 (34.4%), p=0.02]. Given that overall mortality was nominally higher for PES patients [31/50 (62.0%) vs. 61/127 (48.0%), p=0.09], a competing outcome analysis was implemented for TLR against mortality, which demonstrated that the trend for increased TLR with LES was no longer apparent (p=0.282). On multivariable adjustment, only diabetes mellitus was independently associated with TLR (use of PES was not); CONCLUSIONS: Patients on chronic HD experience high rates of clinically driven TLR despite DES implantation. Use of PES does not demonstrate a significant advantage over LES in this population.Copyright © 2014. Published by Elsevier Inc.