Abstract
Aims Chronic kidney disease (CKD) is associated with worse outcomes in patients with coronary artery disease (CAD). How CKD influences the benefit-risk balance of drug-eluting stents (DES) versus bare-metal stents (BMS) is less known. Methods and results In the multicentre BASKET-PROVE trial, 2314 patients in need of large coronary stenting (≥ 3.0 mm) were randomised 2:1 to DES or BMS. In an a priori planned secondary analysis, outcomes were evaluated according to renal function defined by estimated glomerular filtration rates (eGFR; normal: eGFR ≥ 60 ml/min/1.73 m2; CKD: eGFR <60 ml/min/1.73 m2). The primary endpoint was the first major adverse cardiac event (MACE: cardiac death, myocardial infarction, target vessel revascularisation) up to 2 years. A Cox proportional-hazard model was used to evaluate adjusted relative risks (hazard rates, HRs) for BMS versus DES. The interaction of stent type and renal function was tested. CKD patients (189 (11.2%)/1681 with such data) had a 2-year MACE rate of 8.5% versus 7.4% in those without CKD [HR 0.98 (0.56-1.72), p = 0.95] with cardiac mortalities of 5.3% and 1.5%, respectively (p = 0.002, non-significant after baseline adjustments). The MACE rate was lower in CKD patients with DES than with BMS [4.9% versus 15.2%, p = 0.017, HR 0.29(0.10-0.80)] as was the MACE rate in patients without CKD [5.6% with DES versus 11.1% with BMS, p <0.0001, HR 0.51(0.35-0.75)]. No significant interaction between stent type and renal function was found. Conclusions This analysis of patients needing large coronary artery stenting confirms the increased mortality of CKD patients and documents a long-term benefit of DES compared to BMS irrespective of kidney function.
| Original language | English |
|---|---|
| Pages (from-to) | 2381-2388 |
| Number of pages | 8 |
| Journal | International Journal of Cardiology |
| Volume | 168 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Oct 3 2013 |
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Keywords
- Bare metal stent
- Chronic kidney disease
- Coronary artery disease
- Drug eluting stent
- Large coronary artery stenting
- MACE rates
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Medicine(all)
Cite this
Long-term benefits and risks of drug-eluting compared to bare-metal stents in patients with versus without chronic kidney disease. / Wanitschek, Maria; Pfisterer, Matthias; Hvelplund, Anders; De Servi, Stefano; Bertel, Osmund; Jeger, Raban; Rickenbacher, Peter; Iversen, Allan; Jensen, Jan Skov; Galatius, Soeren; Kaiser, Christoph; Alber, Hannes.
In: International Journal of Cardiology, Vol. 168, No. 3, 03.10.2013, p. 2381-2388.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Long-term benefits and risks of drug-eluting compared to bare-metal stents in patients with versus without chronic kidney disease
AU - Wanitschek, Maria
AU - Pfisterer, Matthias
AU - Hvelplund, Anders
AU - De Servi, Stefano
AU - Bertel, Osmund
AU - Jeger, Raban
AU - Rickenbacher, Peter
AU - Iversen, Allan
AU - Jensen, Jan Skov
AU - Galatius, Soeren
AU - Kaiser, Christoph
AU - Alber, Hannes
PY - 2013/10/3
Y1 - 2013/10/3
N2 - Aims Chronic kidney disease (CKD) is associated with worse outcomes in patients with coronary artery disease (CAD). How CKD influences the benefit-risk balance of drug-eluting stents (DES) versus bare-metal stents (BMS) is less known. Methods and results In the multicentre BASKET-PROVE trial, 2314 patients in need of large coronary stenting (≥ 3.0 mm) were randomised 2:1 to DES or BMS. In an a priori planned secondary analysis, outcomes were evaluated according to renal function defined by estimated glomerular filtration rates (eGFR; normal: eGFR ≥ 60 ml/min/1.73 m2; CKD: eGFR <60 ml/min/1.73 m2). The primary endpoint was the first major adverse cardiac event (MACE: cardiac death, myocardial infarction, target vessel revascularisation) up to 2 years. A Cox proportional-hazard model was used to evaluate adjusted relative risks (hazard rates, HRs) for BMS versus DES. The interaction of stent type and renal function was tested. CKD patients (189 (11.2%)/1681 with such data) had a 2-year MACE rate of 8.5% versus 7.4% in those without CKD [HR 0.98 (0.56-1.72), p = 0.95] with cardiac mortalities of 5.3% and 1.5%, respectively (p = 0.002, non-significant after baseline adjustments). The MACE rate was lower in CKD patients with DES than with BMS [4.9% versus 15.2%, p = 0.017, HR 0.29(0.10-0.80)] as was the MACE rate in patients without CKD [5.6% with DES versus 11.1% with BMS, p <0.0001, HR 0.51(0.35-0.75)]. No significant interaction between stent type and renal function was found. Conclusions This analysis of patients needing large coronary artery stenting confirms the increased mortality of CKD patients and documents a long-term benefit of DES compared to BMS irrespective of kidney function.
AB - Aims Chronic kidney disease (CKD) is associated with worse outcomes in patients with coronary artery disease (CAD). How CKD influences the benefit-risk balance of drug-eluting stents (DES) versus bare-metal stents (BMS) is less known. Methods and results In the multicentre BASKET-PROVE trial, 2314 patients in need of large coronary stenting (≥ 3.0 mm) were randomised 2:1 to DES or BMS. In an a priori planned secondary analysis, outcomes were evaluated according to renal function defined by estimated glomerular filtration rates (eGFR; normal: eGFR ≥ 60 ml/min/1.73 m2; CKD: eGFR <60 ml/min/1.73 m2). The primary endpoint was the first major adverse cardiac event (MACE: cardiac death, myocardial infarction, target vessel revascularisation) up to 2 years. A Cox proportional-hazard model was used to evaluate adjusted relative risks (hazard rates, HRs) for BMS versus DES. The interaction of stent type and renal function was tested. CKD patients (189 (11.2%)/1681 with such data) had a 2-year MACE rate of 8.5% versus 7.4% in those without CKD [HR 0.98 (0.56-1.72), p = 0.95] with cardiac mortalities of 5.3% and 1.5%, respectively (p = 0.002, non-significant after baseline adjustments). The MACE rate was lower in CKD patients with DES than with BMS [4.9% versus 15.2%, p = 0.017, HR 0.29(0.10-0.80)] as was the MACE rate in patients without CKD [5.6% with DES versus 11.1% with BMS, p <0.0001, HR 0.51(0.35-0.75)]. No significant interaction between stent type and renal function was found. Conclusions This analysis of patients needing large coronary artery stenting confirms the increased mortality of CKD patients and documents a long-term benefit of DES compared to BMS irrespective of kidney function.
KW - Bare metal stent
KW - Chronic kidney disease
KW - Coronary artery disease
KW - Drug eluting stent
KW - Large coronary artery stenting
KW - MACE rates
UR - http://www.scopus.com/inward/record.url?scp=84885632693&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84885632693&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2013.01.257
DO - 10.1016/j.ijcard.2013.01.257
M3 - Article
VL - 168
SP - 2381
EP - 2388
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 3
ER -