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Impact of stent type and prolonged dual antiplatelet therapy on long-term clinical outcomes in hemodialysis patients with coronary artery disease

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Abstract

The aim of this study was to address 7-year clinical outcomes and impact of prolonged dual antiplatelet therapy (DAPT) after coronary stenting in hemodialysis patients. Our study included 123 consecutive hemodialysis patients who had undergone percutaneous coronary intervention with a drug-eluting stent (DES) or bare-metal stent (BMS) (DES: 64, BMS: 59) in our institution. We compared long-term clinical outcomes following DES with BMS implantation as well as clinical outcomes in patients on DAPT for ≥1 year (DAPT on group, 89) with those on DAPT for <1 year (DAPT off group, 34). We evaluated bleeding events and major adverse cardiac events (MACE), including cardiac death, non-fatal myocardial infarction, target vessel revascularization, and stent thrombosis. At 1 year after stenting, the incidence of MACE was significantly lower in the DES group than in the BMS group (DES versus BMS: 33.2 versus 51.8%; p = 0.045). However, this advantage of DES disappeared by the 7th year (DES versus BMS: 66.0 versus 70.0%; p = 0.42). The cumulative incidence of MACE beyond 1 year was significantly higher in the DAPT on group than in the DAPT off group (DAPT on versus DAPT off: 51.3 versus 18.5%; p = 0.047). The bleeding events in the DAPT on group were 5.1 times greater than in the DAPT off group (DAPT on versus DAPT off: 16.4 versus 3.2%; p = 0.06). Use of DES and prolonged DAPT did not improve 7-year clinical outcomes in hemodialysis patients with coronary artery disease.

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Authors and Affiliations

  1. Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan

    Masahiko Asami, Jiro Aoki, Tatsuyuki Sato, Shuzou Tanimoto, Mika Watanabe, Yu Horiuchi, Koichi Furui, Kentaro Yasuhara, Yu Sato, Takuya Hashimoto, Sen Yachi, Kazuhiro Hara & Kengo Tanabe

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  1. Masahiko Asami
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  2. Jiro Aoki
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  3. Tatsuyuki Sato
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  4. Shuzou Tanimoto
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  5. Mika Watanabe
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  6. Yu Horiuchi
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Correspondence to Masahiko Asami.

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Conflict of interest

Kengo Tanabe receives consultancy from Terumo, Kaneka Medix, and Zeon Medical and remuneration from Abbott Vascular Japan, Sanofi, AstraZeneca, and Daiichi Sankyo. None of the other authors have conflict of interest to declare.

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We complied strictly with the human and animal rights statement in this study.

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Asami, M., Aoki, J., Sato, T. et al. Impact of stent type and prolonged dual antiplatelet therapy on long-term clinical outcomes in hemodialysis patients with coronary artery disease. Cardiovasc Interv and Ther 33, 84–94 (2018). https://doi.org/10.1007/s12928-016-0447-4

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  • DOI: https://doi.org/10.1007/s12928-016-0447-4

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