Drug-eluting stents in patients on chronic hemodialysis: paclitaxel-eluting stents vs. limus-eluting stents. 

 -  2014 
<br/><br/>Available in print through MWHC library: 2002 - present 
<br/><br/> 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).  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.  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). 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1878-0938 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Cardiovascular Agents/ad [Administration & Dosage]<br/>*Coronary Artery Disease/th [Therapy]<br/>*Drug-Eluting Stents<br/>*Everolimus/ad [Administration & Dosage]<br/>*Paclitaxel/ad [Administration & Dosage]<br/>*Percutaneous Coronary Intervention/is [Instrumentation]<br/>*Renal Dialysis<br/>*Renal Insufficiency, Chronic/th [Therapy]<br/>Aged<br/>Chi-Square Distribution<br/>Coronary Artery Disease/co [Complications]<br/>Coronary Artery Disease/di [Diagnosis]<br/>Coronary Artery Disease/mo [Mortality]<br/>Coronary Restenosis/et [Etiology]<br/>Coronary Restenosis/mo [Mortality]<br/>Diabetes Mellitus/mo [Mortality]<br/>District of Columbia/ep [Epidemiology]<br/>Female<br/>Humans<br/>Kaplan-Meier Estimate<br/>Male<br/>Middle Aged<br/>Multivariate Analysis<br/>Myocardial Infarction/et [Etiology]<br/>Myocardial Infarction/mo [Mortality]<br/>Percutaneous Coronary Intervention/ae [Adverse Effects]<br/>Percutaneous Coronary Intervention/mo [Mortality]<br/>Prevalence<br/>Proportional Hazards Models<br/>Prospective Studies<br/>Prosthesis Design<br/>Renal Dialysis/ae [Adverse Effects]<br/>Renal Dialysis/mo [Mortality]<br/>Renal Insufficiency, Chronic/co [Complications]<br/>Renal Insufficiency, Chronic/di [Diagnosis]<br/>Renal Insufficiency, Chronic/mo [Mortality]<br/>Risk Factors<br/>Time Factors<br/>Treatment Outcome
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Heart & Vascular Institute
<br/><br/><label>Index Terms--Function: </label><br/>Comparative Study<br/>Journal Article