Sirolimus-eluting stent is superior to paclitaxel-eluting stent for coronary intervention in patients with renal insufficiency: Long-term clinical outcomes

Cardiol J. 2016;23(6):637-646. doi: 10.5603/CJ.a2016.0065. Epub 2016 Sep 26.

Abstract

Background: Renal insufficiency (RI) is an independent risk factor for the adverse cardiovascular events. Long-term clinical outcome of percutaneous coronary intervention (PCI) in patients with RI is unknown especially in the era of first generation drug-eluting stents (DES). This study aims at comparing clinical outcomes between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) based on large scaled registry.

Methods: Patients who underwent PCI with DES from January 2004 to December 2009 in the Catholic University of Korea-PCI (COACT) registry were prospectively enrolled. A group of 1,033 patients with RI, defined as estimated glomerular filtration rate under 60 mL/min, were analyzed. Major adverse cardiac events (MACE), including all-cause death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR) according to the type of stents were compared.

Results: Median follow-up period was 810 days (interquartile range: from 361 to 1,354 days). A group of 612 (59.2%) patients were treated with SES and 421 (40.8%) patients were treated with PES. The PES vs. SES group had significantly higher rate of MACE (35.9% vs. 28.3%, p = 0.01). In multivariate Cox hazard regression analysis, PES vs. SES group had significantly higher rate of MACE (adjusted hazard ratio [AHR] 1.29, 95% confidence interval [CI] 1.02-1.64, p = 0.033), particularly pronounced by all-cause death (AHR 1.34, 95% CI 1.008-1.770; p = 0.044). In further analysis with propensity score matching, overall findings were consistent.

Conclusions: In patients with RI, PCI using PES provides poorer clinical outcomes than SES in terms of MACE and all-cause death.

Keywords: paclitaxel-eluting stent; percutaneous coronary intervention; renal insufficiency; sirolimus-eluting stent.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Antineoplastic Agents, Phytogenic / pharmacology
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / surgery*
  • Drug-Eluting Stents*
  • Female
  • Follow-Up Studies
  • Humans
  • Immunosuppressive Agents / pharmacology
  • Male
  • Middle Aged
  • Paclitaxel / pharmacology*
  • Percutaneous Coronary Intervention*
  • Prosthesis Design
  • Registries*
  • Renal Insufficiency / complications*
  • Renal Insufficiency / mortality
  • Republic of Korea / epidemiology
  • Risk Factors
  • Sirolimus / pharmacology*
  • Survival Rate / trends
  • Time Factors

Substances

  • Antineoplastic Agents, Phytogenic
  • Immunosuppressive Agents
  • Paclitaxel
  • Sirolimus