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Stent selection among patients with chronic kidney disease: Results from the NCDR CathPCI Registry
Daniel A Feldman1, Adhir R Shroff2, Haikun Bao3
1Section of Cardiology, Adventist Health Portland, Portland, Oregon.
Insights
Drug-eluting stents (DES) are underused in patients with chronic kidney disease (CKD), especially those with advanced renal dysfunction. Despite increased use over time, disparities persist compared to patients with normal kidney function.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Outcomes are superior with drug-eluting stents (DES) compared to bare metal stents (BMS) in chronic kidney disease (CKD) patients undergoing percutaneous coronary interventions (PCIs).
- Perceived barriers may contribute to the underutilization of DES in this high-risk population.
Purpose of the Study:
- To determine current rates of DES usage in patients with varying stages of CKD.
- To analyze trends in DES utilization over time and across different PCI indications.
Main Methods:
- Analysis of 3,650,333 adult PCI cases from the NCDR CathPCI Registry (July 2009 - December 2015).
- Comparison of DES usage rates stratified by CKD stage (I/II, III, IV, V).
- Subgroup analysis by PCI status and indication, linked to Medicare claims for 1-year mortality.
Main Results:
- DES usage declined significantly with worsening renal function (83.0% in Stage I/II to 75.6% in Stage V).
- Lower DES utilization was observed in ST-Elevation Myocardial Infarction (STEMI) cases compared to elective PCIs across all CKD stages.
- DES use increased over time, and was associated with improved 1-year survival.
Conclusions:
- Drug-eluting stents are underutilized in patients with advanced chronic kidney disease.
- Despite an overall increase in DES usage, significant variations persist between CKD patients and those with normal renal function.
Objectives:
This study sought to define contemporary rates of drug eluting stent (DES) usage in patients with chronic kidney disease (CKD).
Background:
Among patients with CKD undergoing percutaneous coronary interventions (PCIs), outcomes are superior for those who receive DES compared to those who receive bare metal stents (BMSs). However, perceived barriers may limit the use of DES in this population.
Methods:
All adult PCI cases from the NCDR CathPCI Registry involving coronary stent placement between July 1, 2009 and December 31, 2015 were analyzed. The rate of DES usage was then compared among four groups, stratified by CKD stage (I/II, III, IV, and V). Subgroup analysis was conducted based on PCI status and indication. Cases were linked to Medicare claims data to assess 1-year mortality.
Results:
A total of 3,650,333 PCI cases met criteria for analysis. DES usage significantly declined as renal function worsened (83.0%, 79.9%, 75.6%, and 75.6%, respectively, in the four CKD stages; p < .001). DES usage was universally lower across the four groups in the setting of ST-Elevation Myocardial Infarction (STEMI) (70.6%, 66.5%, 58.7%, 58.0%; p < .001) and higher in the setting of elective PCI (87.6%, 84.9%, 82.3%, 77.9%; p < .0001). DES was associated with improved 1-year survival, and usage increased over time across each group.
Conclusions:
DESs are underutilized in patients with advanced renal dysfunction. Although DES usage has increased over time, variation still exists between patients with normal renal function and those with CKD.
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