Review Articles

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^§

Author Information

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: [email protected]

Cardiology in Review 26(6):p 277-286, November/December 2018. | DOI: 10.1097/CRD.0000000000000192

Abstract

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.