Impact of chronic kidney disease on the prognosis of patients undergoing percutaneous coronary interventions using drug-eluting stents.

BACKGROUND: Chronic kidney disease (CKD) has an adverse impact on survival of patients with coronary artery disease and is associated with poor outcomes after percutaneous coronary intervention (PCI). Although small randomized, controlled clinical trials showed a reduced target vessel revascularization rate and a good safety profile for sirolimus-eluting coronary stents (SES), safety data need to be confirmed in clinical practice. Therefore, the data of the German DES.DE registry were evaluated to obtain acute and long-term data of this high-risk subgroup.
METHODS: The prospective multicenter German DES.DE registry enables to monitor the therapeutic outcome of different drug-eluting stents in the context of the German Health Care System. Baseline clinical and angiographic characteristics as well as one-year-follow-up data were recorded. From October 2005 to October 2006, 6,384 patients were enrolled at 98 DES.DE sites and stratified according to kidney disease progression: normal and impaired renal function and patients under chronic hemodialysis.
RESULTS: CKD was associated with several acute and chronic medical conditions and suffer from significantly more cardiac and cerebrovascular events after PCI as compared to patients without CKD. One-year-follow-up showed a significantly increased risk of restenosis and bleeding complications in patients with impaired renal function, especially in hemodialysis patients.
CONCLUSIONS: Impaired renal function in patients undergoing DES stenting carries an independent risk factor for restenosis and bleeding.