Impact of end-stage renal disease on clinical and angiographic outcomes after coronary stenting

Although patients with end-stage renal disease (ESRD) are at high risk for restenosis that requires repeat revascularization after balloon angioplasty , their restenosis rate after coronary stenting is still unknown. Over a 4- year period, we performed coronary stenting on 40 lesions in 34 patients wi th ESRD. We compared these lesions with 80 lesions from patients without re nal disease who underwent coronary stenting in the STARS and WINS clinical trials, matched for treatment site, diabetes, lesion length, and reference vessel diameter. Quantitative coronary angiography was performed on all les ions and clinical outcomes were assessed at 9-month follow-vp. Clinical and angiographic characteristics were well matched between the 2 groups and ac ute clinical success rates were similar. Despite comparable initial angiogr aphic results over the 9-month follow-up period, repeat target lesion revas cularization was twice as frequent in the ESRD group compared with the cont rol group (35% vs 16%, p <0.05). After adjusting for differences in postpro cedural minimum lumen diameter and other angiographic and clinical characte ristics, ESRD remained the most important predictor of late target lesion r evascularization (relative risk = 2.3, p = 0.04). In addition, overall 9-mo nth mortality was higher for ESRD patients than for the control population (18% vs 2%, p <0.01). Thus, despite similar angiographic results, patients with ESRD are at higher risk for target lesion revascularization after coro nary stenting than controls. Nonetheless, most patients with ESRD do not de velop restenosis after stent placement, suggesting an important role for st enting in the management of this challenging population. (C) 2000 by Excerp ta Medica, Inc.