Original title: Drug-eluting stents in patients on chronic haemodialysis: Paclitaxel-eluting stents vs. limus –eluting stents Reference: Gabriel l. Sardi, et al. Cardiovasc Revasc Med. 2014 Mar;15(2):86-91.
End Stage Renal Disease (ESRD) including renal failure on hemodialysis is associated with coronary heart disease and diabetes with subsequent need for revascularization that in this special population has a high rate of restenosis and mortality. In this study 218 patients with ESRD on HDA and CHD of which 156 received sirolimus-eluting stents (SES) or everolimus (EES) and 62 patients who received paclitaxel-eluting stents (PES) were included. The primary endpoint was a composite of death, myocardial infarction and revascularization at 2 years and the secondary end point was the target lesion revascularization (TLR) at 2 years also. The average age of the population was 67 years and 71% were diabetic (39 % requiring insulin).
There was no difference in the primary end point at two years (PES 62.7 % versus SES/EES 58.3 %, p = 0.59). Numerically, both TLR and death were half in the PES group at one and two years but did not reach statistical significance (6.8 % versus 12.4 %, p = 0.24 and 11.1% versus 25.8 %, p = 0.06 respectively). A TLR analysis -adjusted by mortality rate, was performed, showing the benefit of PES disappears and diabetes was the only predictor of TLR at 2 years. The insulin requirement was not a TLR predictor.
Hemodialysis patients have a high rate of target lesion revascularization despite the use of drug-eluting stents. The use of paclitaxel – eluting stents showed no significant advantage over releasing limus in this population.
This study shows that results of the PES and SES/EES in patients on HAD is similar (unlike previous studies that favored PES) even with a high rate of death and restenosis. Perhaps bio absorbable stents have a role in improving outcomes or decreased re-interventions.
Courtesy Dr. Carlos Fava
Fundación Favaloro – Buenos Aires
Dr. Carlos Fava para SOLACI.ORG