Dataset Information

The Impact of Renal Dysfunction on the Long Term Clinical Outcomes of Diabetic Patients Undergoing Percutaneous Coronary Intervention in the Drug-Eluting Stent Era.

ABSTRACT:

Background

Limited data are available regarding the association between renal dysfunction and clinical outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) in the drug-eluting stent (DES) era.

Methods

Between March 2003 and December 2010, 2,181 diabetic patients were enrolled in a single-center registry. We divided diabetic patients into a renal dysfunction group (n = 518) and a non-renal dysfunction group (n = 1,663) according to a baseline estimated glomerular filtration rate <60 mL/min/1.73 m2. Propensity score matching analysis was also performed. The primary outcome was cardiac death.

Results

The median follow-up duration was 48 months. The rate of cardiac death was higher in the renal dysfunction group than in the non-renal dysfunction group (14.3% vs. 3.0%, adjusted hazard ratio [HR] 3.63, 95% confidence interval [CI] 2.47 to 5.35, p<0.001). Similarly, the incidence of stent thrombosis was significantly higher in the renal dysfunction group than in the non-renal dysfunction group (4.1% vs. 1.4%, adjusted HR 1.90, 95% CI 1.02 to 3.56, p = 0.04). After 1:1 propensity score matching (502 pairs), patients with renal dysfunction still had a higher rate of cardiac death (13.3% vs. 4.8%, HR 2.58, 95% CI 1.52 to 4.38, p<0.001) although there was no significant difference in the rate of stent thrombosis (4.0% vs. 2.8%, HR 1.31, 95% CI 0.64 to 2.69, p = 0.47).

Conclusions

Renal dysfunction is associated with long-term mortality for diabetic patients undergoing PCI in the DES era.

SUBMITTER: Choi KH

PROVIDER: S-EPMC4701187 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Publications

The Impact of Renal Dysfunction on the Long Term Clinical Outcomes of Diabetic Patients Undergoing Percutaneous Coronary Intervention in the Drug-Eluting Stent Era.

Choi Ki Hong KH Yang Jeong Hoon JH Kim Ji Hwan JH Song Young Bin YB Hahn Joo-Yong JY Choi Jin-Ho JH Gwon Hyeon-Cheol HC Lee Sang Hoon SH Choi Seung-Hyuk SH

PloS one 20160105 1

<h4>Background</h4>Limited data are available regarding the association between renal dysfunction and clinical outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) in the drug-eluting stent (DES) era.<h4>Methods</h4>Between March 2003 and December 2010, 2,181 diabetic patients were enrolled in a single-center registry. We divided diabetic patients into a renal dysfunction group (n = 518) and a non-renal dysfunction group (n = 1,663) according to a baseline estimated ...[more]

PMID: 26731526

Similar Datasets

Project description:BackgroundDrug-eluting stents (DESs) were considered as ground-breaking technology promising to eradicate restenosis and the necessity to perform multiple revascularization procedures subsequent to percutaneous coronary intervention. Soon after DESs were released on the market, however, there were reports of a potential increase in mortality and of early or late thrombosis. In addition, DESs are far more expensive than bare-metal stents (BMSs), which has led to their limited use in many countries. The technology has improved over the last few years with the second generation of DESs (DES-2). Moreover, costs have come down and an improved safety profile with decreased thrombosis has been reported.ObjectivePerform a cost-benefit analysis of DES-2s versus BMSs in the context of a publicly funded university hospital in Quebec, Canada.MethodsA systematic review of meta-analyses was conducted between 2012 and 2016 to extract data on clinical effectiveness. The clinical outcome of interest for the cost-benefit analysis was target-vessel revascularization (TVR). Cost units are those used in the Quebec health-care system. The cost-benefit analysis was based on a 2-year perspective. Deterministic and stochastic models (discrete-event simulation) were used, and various risk factors of reintervention were considered.ResultsDES-2s are much more effective than BMSs with respect to TVR rate ratio (i.e., 0.29 to 0.62 in more recent meta-analyses). DES-2s seem to cause fewer deaths and in-stent thrombosis than BMSs, but results are rarely significant, with the exception of the cobalt-chromium everolimus DES. The rate ratio of myocardial infraction is systematically in favor of DES-2s and very often significant. Despite the higher cost of DES-2s, fewer reinterventions can lead to huge savings (i.e., -$479 to -$769 per patient). Moreover, the higher a patient's risk of reintervention, the higher the savings associated with the use of DES-2s.ConclusionDespite the higher purchase cost of DES-2s compared to BMSs, generalizing their use, in particular for patients at high risk of reintervention, should enable significant savings.

Dataset Information

The Impact of Renal Dysfunction on the Long Term Clinical Outcomes of Diabetic Patients Undergoing Percutaneous Coronary Intervention in the Drug-Eluting Stent Era.

Background

Methods

Results

Conclusions

Publications

The Impact of Renal Dysfunction on the Long Term Clinical Outcomes of Diabetic Patients Undergoing Percutaneous Coronary Intervention in the Drug-Eluting Stent Era.

Similar Datasets

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