Patients with chronic kidney disease (CKD) make up an increasing percentage of the population undergoing percutaneous coronary intervention (PCI).
A new study suggests most older patients with varying severity of CKD benefit from drug-eluting stents (DES) placed during PCI.
Either a bare-metal stent (BMS) or DES may be placed to keep an artery open during PCI.
The DES has emerged as the stent of choice in patients with CKD in response to the high restenosis (recurrence of blockage) rates of 13%-35% seen with BMS.
However, more than 50% of DESs are being placed in patient subgroups that were not included in the large randomized controlled trials.
Concerns have arisen that increased rates of late stent thrombosis in older patients with CKD after implantation with a DES may offset any potential benefit of fewer recurrent blockages.
The new study allays some of those concerns. It found most subgroups of older patients with CKD who received a DES had significantly lower mortality rates throughout 30 months of followup than the patients who received a BMS. Also, the benefits of a DES with regard to myocardial infarction, revascularization, and major bleeding were present in most CKD subgroups.
For more info, see Tsai et al. (2011). Safety and efficacy of drug-eluting stents in older patients with chronic kidney disease. Journal of the American College of Cardiology, 58(180), 1859-1869.