Abstract | OBJECTIVES: BACKGROUND: METHODS: We estimated the glomerular filtration rate (GFR) of 283,593 patients 65 years of age and older who underwent stent implantation between 2004 and 2007. In propensity-matched cohorts grouped by GFR, the association between DES and BMS and the risk of death, MI, revascularization, and major bleeding was examined. RESULTS: A total of 121,446 patients (42.8%) had CKD (GFR <60 ml/min/1.73 m(2)). The 30-month mortality rate for patients on long-term dialysis was 52.0%. In propensity-matched pairs, placement of a DES compared with a BMS in patients with normal renal function was associated with significant reductions in 30-month revascularization (hazard ratio [HR]: 0.91; 95% confidence interval [CI]: 0.86 to 0.95), MI (HR: 0.77; 95% CI: 0.71 to 0.83), and death (HR: 0.73; 95% CI: 0.69 to 0.77), but no difference in bleeding (HR: 0.89; 95% CI: 0.79 to 1.00). Lower MI and mortality rates were also observed after DES compared with BMS implantation in all CKD subgroups with the exception of MI in the long-term dialysis group. Decreased rates of revascularization did not extend to any subgroup of patients with CKD. CONCLUSIONS: The safety of DES compared with BMS is observed in all patients regardless of renal function and is associated with reduced rates of MI and death in some subsets of patients with CKD.
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Authors | Thomas T Tsai, John C Messenger, J Matthew Brennan, Uptal D Patel, David Dai, Robert N Piana, Kevin J Anstrom, Eric L Eisenstein, Rachel S Dokholyan, Eric D Peterson, Pamela S Douglas |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 58
Issue 18
Pg. 1859-69
(Oct 25 2011)
ISSN: 1558-3597 [Electronic] United States |
PMID | 22018296
(Publication Type: Comparative Study, Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)
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Copyright | Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Drug-Eluting Stents
- Female
- Glomerular Filtration Rate
- Humans
- Male
- Medicare
- Myocardial Infarction
- Myocardial Ischemia
(epidemiology, therapy)
- Myocardial Revascularization
(statistics & numerical data)
- Odds Ratio
- Propensity Score
- Registries
- Renal Insufficiency, Chronic
(epidemiology, mortality, physiopathology)
- Severity of Illness Index
- Stents
- United States
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