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KMID : 0338420120270040397
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The Korean Journal of Internal Medicine
2012 Volume.27 No. 4 p.397 ~ p.406
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Comparison of Drug-Eluting Stents in Acute Myocardial Infarction Patients with Chronic Kidney Disease
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:Daisuke Hachinohe
:Jeong Myung-Ho/:Shigeru Saito/:Kim Min-Chol/:Cho Kyung-Hoon/:Khurshid Ahmed/:Hwang Seung-Hwan/:Lee Min-Goo/:Sim Doo-Sun/:Park Keun-Ho/:Kim Ju-Han/:Hong Young-Joon/:Ahn Young-Keun/:Kang Jung-Chaee/:Kim Jong-Hyun/:Chae Shung-Chull/:Kim Young-Jo/:Hur Seung-Ho/:Seong In-Whan/:Hong Taek-Jong/:Choi Dong-Hoon/:Cho Myeong-Chan/:Kim Chong-Jin/:Seung Ki-Bae/:Chung Wook-Sung/:Jang Yang-Soo/:Rha Seung-Woon/:Bae Jang-Ho/:Park Seung-Jung
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Abstract
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Background/Aims: To determine which drug-eluting stents are more effective in acute myocardial infarction (MI) patients with chronic kidney disease (CKD).
Methods: This study included a total of 3,566 acute MI survivors with CKD from the Korea Acute Myocardial Infarction Registry who were treated with stenting and followed up for 12 months: 1,845 patients who received sirolimus-eluting stents (SES), 1,356 who received paclitaxel-eluting stents (PES), and 365 who received zotarolimus-eluting stents (ZES). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 calculated by the modification of diet in renal disease method.
Results: At the 12-month follow-up, patients receiving ZES demonstrated a higher incidence (14.8%) of major adverse cardiac events (MACEs) compared to those receiving SES (10.1%) and PES (12%, p = 0.019). The ZES patients also had a higher incidence (3.9%) of target lesion revascularization (TLR) compared to those receiving SES (1.5%) and PES (2.4%, p = 0.011). After adjusting for confounding factors, ZES was associated with a higher incidence of MACE and TLR than SES (adjusted hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.442 to 0.879; p = 0.007; adjusted HR, 0.350; 95% CI, 0.165 to 0.743; p = 0.006, respectively), and with a higher rate of TLR than PES (adjusted HR, 0.471; 95% CI, 0.223 to 0.997; p = 0.049).
Conclusions: Our findings suggest that ZES is less effective than SES and PES in terms of 12-month TLR, and has a higher incidence of MACE due to a higher TLR rate compared with SES, in acute MI patients with CKD.
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KEYWORD
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Myocardial infarction, Renal insufficiency, Chronic, Stents
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