Coronary Stents in Patients with ST-Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention
- Coronary Stents in Patients with ST-Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention
- 김영조; 정명호[정명호]; Khurshid Ahmed[Khurshid Ahmed]; Rabin Chakraborty[Rabin Chakraborty]; Sumera Ahmed[Sumera Ahmed]; 심두선[심두선]; 박근호[박근호]; 김주한[김주한]; 안영근[안영근]; 강정채[강정채]; 조명찬[조명찬]; 김청진[김청진]
- Myocardial infarction; Stents; Angioplasty; Kidney failure; chronic.
- Issue Date
- Korean Circulation Journal, v.42, no.12, pp.830 - 838
- Background and Objectives: Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI).
We sought to compare different coronary stents used during primary PCI in patients with ST-elevation myocardial infarction (STEMI) and CKD.
Subjects and Methods: We selected 2408 consecutive STEMI patients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m 2 )undergoing primary PCI and divided them into 5 groups based on the type of stent implanted: 1) bare metal stent (BMS), 2) paclitaxel-eluting stent (PES), 3) sirolimus-eluting stent (SES), 4) zotarolimus-eluting stent (ZES), or 5) everolimus-eluting stent (EES). The study end-point was the number of major adverse cardiac events (MACE) at 12 months.
Results: There was no significant difference in the incidence of 12-month myocardial infarction, target lesion revascularization, or target vessel revascularization between stent groups; however, the overall rate of repeat revascularization differed significantly between groups.
All-cause death differed significantly among the groups. The incidence of 12-month MACE in BMS, PES, SES, ZES, and EES was 8.3%, 9.8%,8.6%, 5.5%, and 2.6%, respectively (p<0.001). Kaplan-Meier analysis did not show a significant differences in 12-month MACE-free survival among the groups (log-rank p=0.076). This finding remained the same after adjusting for multiple confounders (p=0.147).
Conclusion: Any of the 5 stents can be used to treat STEMI patients with CKD undergoing primary PCI; all have similar risk of 12-month MACE. This result is hypothesis-generating and warrants further evaluation with a long-term randomized study.
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