Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Coronary Stents in Patients with ST-Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention

  • Ahmed, Khurshid (The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences) ;
  • Jeong, Myung Ho (The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences) ;
  • Chakraborty, Rabin (Apollo Gleneagles Hospital) ;
  • Ahmed, Sumera (Apollo Gleneagles Hospital) ;
  • Hong, Young Joon (The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences) ;
  • Sim, Doo Sun (The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences) ;
  • Park, Keun Ho (The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences) ;
  • Kim, Ju Han (The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences) ;
  • Ahn, Youngkeun (The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences) ;
  • Kang, Jung Chaee (The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences) ;
  • Cho, Myeong Chan (Department of Internal Medicine, Chungbuk National University Hospital) ;
  • Kim, Chong Jin (Department of Internal Medicine, East West Neo Medical Center) ;
  • Kim, Young Jo (Department of Internal Medicine, Yeungnam University Hospital)
  • Published : 2012.12.31
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Abstract

Background and Objectives: Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). We sought to compare different coronary stents used during primary PCI in patients with ST-elevation myocardial infarction (STEMI) and CKD. Subjects and Methods: We selected 2408 consecutive STEMI patients with CKD (estimated glomerular filtration rate <60 mL/min/$1.73m^{2}$) undergoing primary PCI and divided them into 5 groups based on the type of stent implanted: 1) bare metal stent (BMS), 2) paclitaxel-eluting stent (PES), 3) sirolimus-eluting stent (SES), 4) zotarolimus-eluting stent (ZES), or 5) everolimus-eluting stent (EES). The study endpoint was the number of major adverse cardiac events (MACE) at 12 months. Results: There was no significant difference in the incidence of 12-month myocardial infarction, target lesion revascularization, or target vessel revascularization between stent groups; however, the overall rate of repeat revascularization differed significantly between groups. All-cause death differed significantly among the groups. The incidence of 12-month MACE in BMS, PES, SES, ZES, and EES was 8.3%, 9.8%, 8.6%, 5.5%, and 2.6%, respectively (p<0.001). Kaplan-Meier analysis did not show a significant differences in 12-month MACE-free survival among the groups (log-rank p=0.076). This finding remained the same after adjusting for multiple confounders (p=0.147). Conclusion: Any of the 5 stents can be used to treat STEMI patients with CKD undergoing primary PCI; all have similar risk of 12-month MACE. This result is hypothesis-generating and warrants further evaluation with a long-term randomized study.

Keywords

References

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