Drug-Eluting Stents Safe for Most Older CKD Patients

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Drug-eluting stents are safe to use in older patients undergoing percutaneous coronary interventions regardless of renal function, researchers concluded.

In addition, use of these stents are associated with lower risks of death and myocardial infarction (MI) in patients with normal renal function and most subgroups of patients with chronic kidney disease (CKD) compared with the use of bare-metal stents, according to a report in the Journal of the American College of Cardiology (2011;58:1859-1869).

Drug-eluting stents have emerged as the stent of choice for CKD patients in response to the high stenosis rates of 13% to 35% observed with bare-metal stents, the researchers noted.

The findings, by Thomas Tsai, MD, MSc, of the Denver VA Medical Center, and colleagues emerged from an analysis of data from 283,593 patients aged 65 years and older who received stents from 2004-2007. The study population included 162,147 patients with normal renal function, 73,751 with mild CKD, 34,004 with moderate CKD, and 8,509 with severe CKD, and 5,182 on long-term dialysis.

Compared with the use of bare-metal stents, the use of drug-eluting stents was associated with lower 30-month death rates in patients with normal renal function (11.9 vs. 14.6%), mild CKD (15% vs. 18.6%) and moderate CKD (24.7% vs. 26.8%).

Drug-eluting stents also were associated with significantly lower 30-month MI rates compared with bare-metal stents for all groups except patients on long-term dialysis: 5.7 vs. 7.0 for patients with normal renal function; 6.5 vs. 7.3 for patients with mild CKD; 9.6 vs. 11.9 for individuals with moderate CKD; and 15.0 vs. 12.8 for those with severe CKD.

At 30-month follow-up, patients on dialysis had a 3.6-fold increased risk of death, a 2.1-fold increased risk of MI, and a 2.3-fold increased risk of major bleeding compared with patients who had normal renal function, the authors noted.

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