Background: The comparative effectiveness of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus bare metal stents (BMS) has not been studied in the kidney transplant population.
Methods: Using the US Renal Data System, we identified 3245 kidney transplant patients who underwent PCI between April 2003 and December 2010; 2400 and 845 patients received DES and BMS, respectively. We used propensity score matching and inverse probability of treatment weighting to create DES- and BMS-treated groups whose observed baseline characteristics were well-balanced. The associations between stent type and the outcomes of (1) death; (2) death or myocardial infarction (MI); (3) death, MI, or repeat revascularization (RR); and (4) hospitalized bleeding were compared using Cox proportional hazards regression.
Results: Drug-eluting stent use increased during the study period, mirroring the trend described in the general population. In the propensity score-matched cohort, no significant association among DES (vs BMS) use and outcomes was observed at 1 and 2 years of follow-up. However, at 3 years, DES was associated with 20% (95% confidence interval [CI], 4-33%) lower risk of death, 15% (95% CI, 1-27%) lower risk of death or MI, and 14% (95% CI, 2-24%) lower risk of death, MI, or repeat revascularization. There were no significant differences in rates of hospitalized bleeding at any time point. Results were similar in the inverse probability of treatment weighting analysis.
Conclusions: In this retrospective study of US kidney transplant recipients undergoing PCI, DES was associated with better clinical outcomes beyond 2 years of follow-up.
This retrospective registry study of US kidney transplant recipients undergoing percutaneous coronary intervention suggests that the use of drug-eluting stents is increasing and is associated lower risk of death, myocardial infarction or repeat revascularization compared to bare-metal stents.
1 Division of Nephrology, Department of Medicine, Stanford School of Medicine, Palo Alto, CA.
2 Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
Received 5 February 2016. Revision received 1 July 2016.
Accepted 5 July 2016.
T.I.C. is supported by a grant from the NIDDK (5K23DK095914). C.R.L. is supported by an American Heart Association Western States Affiliate Mentored Clinical & Population Research Award.
The authors declare no conflicts of interest.
All authors give final approval of the submitted article. C.R.L. participated in the design and interpretation of data for the analysis; drafting the first version of the article, and revising it critically for important intellectual content. M.M.R. participated in the design and interpretation of data for the analysis; revising the article critically for important intellectual content. W.C.W. participated in the conception and design of the work; acquisition and interpretation of the data for the article; revising the article critically for important intellectual content. T.I.C. participated in conception and design of the work; acquisition and interpretation of the data for the article; drafting of figures and tables; revising the manuscript critically for important intellectual content. T.I.C. had access to all the data and agrees to be accountable for all aspects of the work.
Correspondence: Tara I. Chang, MD, MS, Division of Nephrology, Stanford University School of Medicine 777 Welch Road, Suite D, Palo Alto, CA 94304. (Tichang@Stanford.Edu).
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