Long-term benefits and risks of drug-eluting compared to bare-metal stents in patients with versus without chronic kidney disease

Maria Wanitschek, Matthias Pfisterer, Anders Hvelplund, Stefano De Servi, Osmund Bertel, Raban Jeger, Peter Rickenbacher, Allan Iversen, Jan Skov Jensen, Soeren Galatius, Christoph Kaiser, Hannes Alber

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)2381-2388
Number of pages8
JournalInternational Journal of Cardiology
Volume168
Issue number3
DOIs
Publication statusPublished - Oct 3 2013

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Chronic Renal Insufficiency
Drug-Eluting Stents
Stents
Metals
Pharmaceutical Preparations
Kidney
Mortality
Glomerular Filtration Rate
Proportional Hazards Models
Coronary Artery Disease
Coronary Vessels
Myocardial Infarction

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 journalArticle

Wanitschek, M, Pfisterer, M, Hvelplund, A, De Servi, S, Bertel, O, Jeger, R, Rickenbacher, P, Iversen, A, Jensen, JS, Galatius, S, Kaiser, C & Alber, H 2013, 'Long-term benefits and risks of drug-eluting compared to bare-metal stents in patients with versus without chronic kidney disease', International Journal of Cardiology, vol. 168, no. 3, pp. 2381-2388. https://doi.org/10.1016/j.ijcard.2013.01.257
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. / Long-term benefits and risks of drug-eluting compared to bare-metal stents in patients with versus without chronic kidney disease. In: International Journal of Cardiology. 2013 ; Vol. 168, No. 3. pp. 2381-2388.
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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.",
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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

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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

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