Randomized Comparison of Xience V and Multi-Link Vision Coronary Stents in the Same Multivessel Patient With Chronic...

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Percutaneous coronary interventions (PCI) in patients with chronic kidney disease (CKD) yield suboptimal outcomes.
• Drug-eluting stents (DES) may offer improved results over bare-metal stents (BMS) in CKD patients.
• Assessing neointimal growth post-PCI in CKD is complex due to multiple confounding variables.

Purpose of the Study:

• To directly compare the efficacy of everolimus-eluting stents (Xience V DES) versus BMS with identical designs in preventing clinical restenosis.
• To evaluate outcomes in patients with multivessel coronary artery disease and CKD (eGFR <60 mL/min).

Main Methods:

• Prospective, randomized, multicenter study (RENAL-DES trial).
• Comparison of Xience V DES and Multi-Link Vision BMS implanted in the same multivessel CKD patient.
• Primary endpoint: ischemia-driven target vessel revascularization at 12 months, assessed by myocardial scintigraphy.

Main Results:

• A total of 512 coronary vessels in 215 patients were treated.
• Ischemia-driven target vessel revascularization rates at 1 year were significantly lower for DES (2.7%) versus BMS (11.4%) (P<0.001).
• Independent predictors of revascularization included BMS implantation (OR, 4.95) and smaller vessel size (OR, 0.32).

Conclusions:

• This is the first randomized trial demonstrating reduced clinical restenosis with a new-generation DES compared to an identical BMS design in CKD patients.
• Everolimus-eluting stents represent a superior treatment option for multivessel coronary artery disease in patients with chronic kidney disease.