Drug-Eluting Stents in Patients with Chronic Kidney Disease A Prospective Registry Study 英文参考文献.docVIP

Drug-ElutingStentsinPatientswithChronicKidney Disease:AProspectiveRegistryStudy ChetanShenoy1,JudyBoura2,PamelaOrshaw1,KishoreJ.Harjai1* 1GuthrieClinic,Sayre,Pennsylvania,UnitedStatesofAmerica,2WilliamBeaumontHospital,RoyalOak,Michigan,UnitedStatesofAmerica Abstract Background: Chronic kidney disease (CKD) is strongly associated with adverse outcomes after percutaneous coronary intervention(PCI).Therearelimiteddataontheeffectivenessofdrug-elutingstents(DES)inpatientswithCKD. Methodology/Principal Findings: Of 3,752 consecutive patients enrolled in the Guthrie PCI Registry between 2001 and 2006,436patientswithCKD-definedasacreatinineclearance,60mL/min-wereincludedinthisstudy.Patientswho receivedDESwerecomparedtothosewhoreceivedbaremetalstents(BMS).Patientswerefollowedforameandurationof 3 years after the index PCI to determine the prognostic impact of stent type. Study end-points were all-cause death, myocardialinfarction(MI),targetvesselrevascularization(TVR),stentthrombosis(ST)andthecompositeofmajoradverse cardiovascular events (MACE), defined as death, MI or TVR. Patients receiving DES in our study, by virtue of physician selection,hadmorestablecoronaryarterydiseaseandhadlowerbaselineriskofthromboticorrestenoticevents.Kaplan- Meierestimatesofproportionsofpatientsreachingtheend-pointsweresignificantlylowerforDESvs.BMSforall-cause death(p=0.0008),TVR(p=0.029)andMACE(p=0.0015),butnotMI(p=0.945)orST(p=0.88).Multivariableanalysiswith propensityadjustmentdemonstratedthatDESimplantationwasanindependentpredictoroflowerratesofall-causedeath (hazardratio[HR]0.48,95%confidenceinterval[CI]0.25–0.92),TVR(HR0.50,95%CI0.27–0.94)andMACE(HR0.62,95%CI 0.41–0.94). Conclusions:InacontemporaryPCIregistry,selectiveuseofDESinpatientswithCKDwassafeandeffectiveinthelong term,withlowerriskofall-causedeath,TVRandMACEandsimilarriskofMIandSTascomparedwithBMS.Themortality benefitmaybearesultofselectionbiasandresidualconfounding,orrepresentatruefinding;ahypothesisthatwarrants clarificationbyra