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Coron Artery Dis. 2012 Dec;23(8):528-32. doi: 10.1097/MCA.0b013e3283599463.

Impact of chronic kidney disease on a re-percutaneous coronary intervention for sirolimus-eluting stent restenosis.

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Department of Cardiology, Nagoya University Graduate School of Medicine, Japan.



Recurrent in-stent restenosis remains an important clinical issue after a percutaneous coronary intervention even after treatment with a sirolimus-eluting stent (SES) especially in patients with chronic kidney disease. We evaluated the impact of renal insufficiency on the clinical and angiographic outcomes after treatment for SES restenosis.


A total of 74 patients with 76 lesions underwent subsequent revascularization with a drug-eluting stent for SES restenosis. Patients were classified into three groups: group 1 included 29 patients with an estimated glomerular filtration rate more than 60 ml/min/1.73 m(2); group 2 included 27 patients with lower estimated glomerular filtration rate (<60 ml/min/1.73 m(2)) without hemodialysis (HD) dependence; and group 3 included 18 patients on HD. Clinical and angiographic follow-up was carried out at 8 months. Late lumen loss at the 8-month follow-up angiography showed progressive increases from group 1 to 2 to 3 (group 1: 0.36 ± 0.39 mm, group 2: 1.11 ± 0.61 mm, group 3: 1.30 ± 0.85 mm, P<0.001). Similarly, compared with group 1, groups 2 and 3 had significantly higher rates of major adverse cardiac events (6.9, 37.0, and 38.9%, respectively, P=0.001), primarily because of a high frequency of target lesion revascularization (8.0, 34.8, and 33.3%, respectively, P=0.019).


Non-HD-dependent chronic kidney disease patients had increased neointimal growth in the follow-up phase after percutaneous coronary intervention, with a drug-eluting stent for SES restenosis almost equivalent to patients on HD, resulting in higher rates of recurrent restenosis than patients with preserved renal function.

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