Drug eluting stents in renal functional insufficiency patients and its influence on stent thrombosis / 中国综合临床

ABSTRACT

Objective To understand the application of drug eluting stent (DES) in renal functional insufficient patients, and to assess its safety and effectiveness, especially the occurrence of stent thrombosis(ST) after DES implantation and its related factors. Methods The subjects were all the patients underwent percutaneous coronary intervention (PCI) as well as at least one DES admitted to Beijing Anzhen Hospital consecutively from July 2003 to June 2005. All patients were divided into 2 groups Group Ⅰ with normal or mild renal insufficiency (Ccr≥60 ml/min),and Group Ⅱ with moderate to severe renal functional insufficiency (Ccr ＜ 60 ml/min). All of the clinical, angiography and intervention data were recorded. ST was adjudicated by the definition of ARC Dublin. The rates of MACCE in hospital and during the follow-up between the 2 groups were compared. Results There were 2377 patients enrolled in the study, of which 2020 ( 85.0% ) patients presented Ccr ≥ 60 ml/min, and 357( 15.0% ) presented Ccr ＜ 60ml/min. The case fatality during follow-up in group Ⅰ was significantly higher than that in group Ⅱ (4. 5% vs. 1.2%, P ＜ 0. 001 ). However, the incidences of ST were not significantly different between each stage of disease( P ＞0. 05 ). The results from Cox regression showed that renal functional insufficiency was not a risk factor of death,whereas multivessel coronary artery disease [OR = 1. 929(95% CI 1. 178 -3. 157),P =0. 009] ,diabetes [OR = 1. 914(95% CI1. 055 -3. 470) ,P =0. 033] and age [OR = 1. 051 (95% CI1. 005 -1. 099 ) ,P = 0. 030] were independent risk factor of death after DES implantation in patients with moderate to severe renal functional insufficiency. Conclusions Compared with normal renal function or mild renal patients, the longterm case fatality is higher in moderate and severe renal functional insufficiency patients. However, the higher case fatality does not due to the increase of ST.