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Long-term prognosis of patients with coronary heart disease and mild to moderate renal dysfunction after implantation of biodegradable polymer or durable polymer-coated drug-eluting stents — insight from the I-LOVE-IT 2 trial

By Long CHENG, Yi LI, Jing LI, He-yang WANG, Miao-han QIU, Wen-jing DOU, Xu WANG, Chu-yuan FANG and Ya-lin HAN

Abstract

Objective  To compare the prognosis of patients with coronary heart disease and different degrees of renal dysfunction after implantation of biodegradable polymer-coated sirolimus-eluting stents (BP-SES) or durable polymer-coated sirolimus-eluting stents (DP-SES). Methods  From the I-LOVE-IT2 study, 2603 patients [1744 were implanted with BP-SES and 859 with DP-SES] were divided into different subgroups according to the estimated glomerular filtration rate (eGFR): in BP-SES group, normal renal function subgroup (eGFR>90ml/(min.1.73m2), n=1136), mild renal insufficiency subgroup (90ml/ (min.1.73m2)>eGFR>60ml/(min.1.73m2), n=513), and moderate renal insufficiency subgroup (60ml/(min.1.73m2)>eGFR>30ml/ (min.1.73m2), n=95); in DP-SES group, normal renal function subgroup (eGFR>90ml/(min.1.73m2), n=570), mild renal insufficiency subgroup (90ml/(min.1.73m2)>eGFR>60ml/(min.1.73m2), n=254), and moderate renal insufficiency subgroup (60ml/(min.1.73m2)>eGFR>30ml/(min.1.73m2), n=35). The primary endpoint of the study was 12-month target lesion failure (TLF), including cardiac death, target vascular myocardial infarction (TVMI), and clinically indicated target lesion revascularization (CI-TLR); the secondary endpoint was 12-months net adverse clinical and cerebral events (NACCE), including all-causes of death, all myocardial infarction, stroke, and severe hemorrhage [bleeding academic research consortium (BARC 3-5)]. Results  In BP-SES group, clinical follow-up in 12 months indicated no significant difference in TLF among the three subgroups (6.2% vs. 5.5% vs. 8.5%, P=0.53), but the incidence of cardiac death was higher in moderate renal insufficiency subgroup than in the other two subgroups (0.4% vs. 0.2% vs. 4.3%, P<0.01). No significant difference existed in the incidence of 12-month CI-TLR (3.6% vs. 2.6% vs. 2.1%, P=0.46) and TVMI (3.3% vs. 3.9% vs. 5.4%, P=0.45) among the 3 subgroups. The incidence of NACCE in the secondary endpoint was higher in moderate renal insufficiency subgroup (13.7%, P=0.02) than in normal renal function subgroup and mild renal insufficiency subgroup (6.2% vs. 6.4%, P=0.88). Moreover, marked differences existed on all-cause mortality (0.7 % vs. 0.9% vs. 6.3%, P<0.01) and all myocardial infarction (1.1% vs. 2.6% vs. 4.4%, P=0.01) among the 3 subgroups with BP-SES. In DP-SES group, significant difference existed on TLF (5.1% vs. 7.5% vs. 14.3%, P=0.05), NACCE (6.8% vs. 6.3% vs. 17.1%, P=0.05) and TVMI (4.0% vs. 3.9% vs. 14.3%, P=0.01) among the 3 subgroups. Moreover, the incidence was highest in the moderate renal insufficiency subgroup. Forest plot indicated no difference existed between BP-SES and DP-SES group in different degrees renal dysfunction patients. Conclusions  The risk of death and myocardial infarction significantly increased in patients with coronary heart disease and moderate renal insufficiency after implantation of drug-eluting stents than in those with normal renal function or mild renal insufficiency. No significant difference exists in the long-term prognosis of patients with different degrees of renal insufficiency after implantation of BP-SES or DP-SES. DOI: 10.11855/j.issn.0577-7402.2018.09.1

Topics: renal insufficiency, coronary atherosclerotic heart disease, percataneous coronary intervention, biodegradable coating stent, prognosis, Medicine, R, Medicine (General), R5-920
Publisher: Editorial Board of Medical Journal of Chinese People's Liberation Army
Year: 2018
OAI identifier: oai:doaj.org/article:fa04bd964796470eb7bced6aa8fe0f61
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