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Two-year clinical outcomes of biodegradable polymer versus durable polymer drug-eluting stent implantation in hemodialysis patients after percutaneous coronary intervention

Session Poster Session 7

Speaker Shota Okuno

Congress : ESC Congress 2019

  • Topic : cardiovascular disease in special populations
  • Sub-topic : Renal Failure and Cardiovascular Disease
  • Session type : Poster Session
  • FP Number : P6241

Authors : S Okuno (Amagasaki,JP), T Ishihara (Amagasaki,JP), O Iida (Amagasaki,JP), M Asai (Amagasaki,JP), M Masuda (Amagasaki,JP), S Okamoto (Amagasaki,JP), K Nanto (Amagasaki,JP), T Kanda (Amagasaki,JP), T Tsujimura (Amagasaki,JP), Y Matsuda (Amagasaki,JP), Y Hata (Amagasaki,JP), H Uematsu (Amagasaki,JP), Y Sato (Amagasaki,JP), T Mano (Amagasaki,JP)

Authors:
S Okuno1 , T Ishihara1 , O Iida1 , M Asai1 , M Masuda1 , S Okamoto1 , K Nanto1 , T Kanda1 , T Tsujimura1 , Y Matsuda1 , Y Hata1 , H Uematsu1 , Y Sato1 , T Mano1 , 1Kansai Rosai Hospital - Amagasaki - Japan ,

Citation:

Background: Biodegradable polymer drug-eluting stent (BP-DES) has been developed to improve clinical outcomes after percutaneous coronary intervention (PCI) for patients presenting coronary artery disease (CAD). Although BP-DES showed non-inferior safety and efficacy to durable polymer DES (DP-DES) in several randomized clinical trials, hemodialysis (HD) patients, who have been well known as high risk population for adverse events, were excluded in the most of trials. Therefore, there are limited data comparing the clinical outcomes between BP-DES and DP-DES in HD patients with CAD after PCI.

Purpose: The purpose of this study was to investigate clinical outcomes in HD patients after BP-DES implantation compared with those after DP-DES implantation.

Methods: We retrospectively analyzed 234 HD patients (male 74%, mean age 71±10 years) undergoing PCI for 404 lesions with 472 DESs (71 patients for 138 lesions with 170 BP-DESs [91 Ultimaster and 79 Synergy] and 163 HD patients for 266 lesions with 302 DP-DESs [219 Xience, 53 Promus and 30 Resolute]) from 2011 to 2017. Two-year clinical outcomes were compared between BP-DES group and DP-DES group. The primary outcome measure was the incidence of target lesion revascularization (TLR), while the secondary outcome measures were the occurrence of cardiac death (CD), stent thrombosis (ST), myocardial infraction (MI), target vessel revascularization (TVR), non-TVR and major adverse cardiac event (MACE) defined as a composite of CD, MI, and TVR. Outcome measures were estimated by the Kaplan-Meier method and the differences between BP-DES group and DP-DES group were assessed by the log-rank test. We also conducted Cox’s proportional hazard model to identify predictors for TLR occurrence.

Results: Baseline patient and lesion characteristics were similar between the two groups. The two-year incidence of TLR was not significantly different between BP-DES group and DP-DES group (14.1% vs. 22.2%, p=0.391). The two-year incidences of CD (17.3% vs. 17.5%, p=0.381), ST (0% vs. 3.9%, p=0.133), MI (4.2 % vs. 5.8%, p=0.965), TVR (21.3% vs. 27.5%, p=0.586), non-TVR (26.1% vs. 31.3%, p=0.439) and MACE (41.1% vs. 42.6%, p=0.526) were also not different between the two groups. After multivariate analysis, diabetes mellitus (hazard ratio 1.97; 95% confidence interval 1.03-3.78, p=0.004) was independently associated with TLR occurrence in HD patients.

Conclusions: At two-year follow-up after PCI, BP-DES had comparable safety and efficacy profiles to DP-DES in HD patients presenting CAD.

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