Drug-eluting stents appear safe for older patients with chronic kidney disease
Patients with chronic kidney disease (CKD) make up an increasing percentage of the population undergoing percutaneous coronary intervention (PCI). A new study suggests that most older patients with varying severity of CKD benefit from drug-eluting stents (DES) placed during PCI. Either a bare-metal stent (BMS) or DES may be placed to keep an artery open during PCI. The DES has emerged as the stent of choice in CKD patients in response to the high restenosis (recurrence of blockage) rates of 13 to 35 percent seen with BMS. However, more than 50 percent of DESs are being placed in patient subgroups that were not included in the large randomized controlled trials. Concerns have arisen that increased rates of late stent thrombosis in older patients with CKD after implantation with a DES may offset any potential benefit of fewer recurrent blockages.
The new study allays some of those concerns. It found that most subgroups of older patients with CKD who received a DES had significantly lower mortality rates throughout 30 months of followup than the patients who received a BMS. Also, the benefits of a DES with regard to myocardial infarction, revascularization, and major bleeding were present in most CKD subgroups.
The study population included 285,593 Medicare patients undergoing PCI who were enrolled in a registry containing information on patients who had received PCIs. Patients receiving PCI were classified into five groups based on their estimated level of kidney function, as measured by the estimated glomerular filtration rate. The five groups were: normal, mild, moderate, severe CKD, and severe CKD with long-term dialysis. The study was supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-05-0032).
See "Safety and efficacy of drug-eluting stents in older patients with chronic kidney disease," by Thomas T. Tsai, M.D., John C. Messenger, M.D., J. Mathew Brennan, M.D., and others in the Journal of the American College of Cardiology 58(180), pp. 1859-1869, 2011.
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