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Long-Term Outcomes of Drug-Eluting Stents Versus Bare-Metal Stents in End-Stage Renal Disease Patients on Dialysis

A Systematic Review and Meta-Analysis

Khera, Sahil, MD, MPH*; Villablanca, Pedro A., MD, MSc; Kolte, Dhaval, MD, PhD; Gupta, Tanush, MD; Hasan Khan, Mohammed, MD§; Velagapudi, Poonam, MD, MS; Kalra, Ankur, MD; Kleiman, Neal, MD; Aronow, Herbert D., MD, MPH; Abbott, J. Dawn, MD; Rosenfield, Kenneth, MD, MHCDS*; Drachman, Douglas E., MD*; Bangalore, Sripal, MD, MHA**; Bhatt, Deepak L., MD, MPH††; Naidu, Srihari S., MD§

doi: 10.1097/CRD.0000000000000192
Review Articles

There are no dedicated data to guide drug-eluting stent (DES) versus bare-metal stent (BMS) selection in patients with end-stage renal disease undergoing dialysis (ESRD-D). It is unclear whether long-term benefits of a specific stent type outweigh risks in this population at high risk for both bleeding and ischemic events. We performed a meta-analysis of nonrandomized studies extracted from PubMed, Scopus, and EMBASE, assessing the safety and effectiveness of DES versus BMS in ESRD-D patients. Odds ratios (OR) and 95% confidence intervals (CI) were computed with the Mantel–Haenszel method. Random-effects model was used for all analyses. A total of 17 nonrandomized studies (N = 63,157; 41,621 DES and 21,536 BMS) met the inclusion criteria and were included for the final quantitative analysis: median follow-up of 1 year (range: 9 months to 6 years). The use of DES in ESRD-D patients was associated with lower all-cause mortality (OR 0.75, 95% CI 0.64–0.89, P < 0.001) compared with BMS. The use of DES was also associated with lower rates of cardiovascular mortality (OR 0.75, 95% CI 0.60–0.99, P = 0.047) and target lesion/vessel revascularization (OR 0.78, 95% CI 0.64–0.94, P = 0.01). However, there were no differences in noncardiovascular mortality, myocardial infarction, stent thrombosis, stroke, or major bleeding in DES versus BMS. In this largest meta-analysis of long-term outcomes after percutaneous coronary intervention in ESRD-D patients, DES was associated with lower rates of all-cause mortality, target lesion/vessel revascularization, and cardiovascular death.

From the *Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA

Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY

Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI

§Division of Cardiology, New York Medical College and Westchester Medical Center, Valhalla, NY

Harrington Heart & Vascular Institute at University Hospitals Cleveland Medical Center, Cleveland, OH

Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX; Weill Cornell Medical College, New York, NY

**Division of Cardiology, New York University Medical Center, New York, NY

††Division of Cardiology, Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA.

Disclosures: Dr S.S.N. discloses the following relationships: Advisory Board: Abbott Vascular. Dr D.E.D. discloses the following relationships: Consultant: Abbott Vascular, St. Jude Medical, Corindus Vascular Robotics; Uncompensated Research Grant Support: Lutonix/Bard, Atrium Medical, ReCor Medical. Dr D.L.B. discloses the following relationships: Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute; NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical; Unfunded Research: FlowCo, PLx Pharma, Takeda. Dr S.B. discloses the following relationships: Research grant from Abbott Vascular; Advisory board: Abbott Vascular; Research grant from NHLBI. Dr K.R. discloses the following relationships: Advisory Board: Abbott Vascular, Cardinal Health, Surmodics, Volcano-Philips, Cook, Amgen; Grant support/Research funding to institution: Angiodynamics, Atrium-Getinge, Lutonix-BARD, National Institutes of Health, Inari Medical; Equity: PQ Bypass, Primacea, Vortex, MD Insider, Micell, Shockwave, Cruzar Systems, Endospan, Eximo, Valcare, Contego, Capture Vascular; Board of Directors: VIVA—501c3 corporation; President: Society for Cardiovascular Angiography and Interventions; President: National PERT Consortium - 501c3 corporation. All other authors report no conflicts of interest.

Presented at the Society for Cardiovascular Angiography and Intervention’s Scientific Sessions, May 11, 2017, New Orleans, LA.

Correspondence: Srihari S. Naidu, MD, Hypertrophic Cardiomyopathy Program, Interventional Cardiology, Westchester Medical Center, 100 Woods Road, Macy Pavilion No. 134, Valhalla, NY 10595. E-mail:

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