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Kidney Disease in the Cardiac Catheterization Laboratory pp 119–131Cite as

Choice of Stents and Clinical Outcomes in Patients with Chronic Kidney Disease

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Abstract

Advances in coronary stent technology have led to iterative reductions in the risk of target vessel revascularization (TVR) as well as stent thrombosis (ST) following percutaneous coronary intervention (PCI). However, patients with chronic kidney disease (CKD) are characterized by unique risk factors that ought to be considered when selecting a coronary stent. In addition to the systemic risk factors in patients with CKD, atherosclerotic lesions are more calcified, longer, and more vulnerable with a larger necrotic core. Nevertheless, post hoc analyses of randomized clinical trials (RCT) suggest that renal impairment does not augment risk for in-stent late loss. Conversely, renal dysfunction is associated with both an increased risk of thrombotic and bleeding complications following PCI. When comparing stent platforms in patients with CKD, second-generation drug-eluting stents (DES) appear more efficacious and safe than bare-metal stents (BMS) with lower risks for TVR, ST, and myocardial infarction (MI). Observational data have questioned the incremental benefit of DES in CKD patients, but it is uncertain how much of the differences are confounded by patient characteristics and study design. RCTs specifically studying post-PCI outcomes in CKD patients are needed along with newer technologies such as polymer-free and antibody-eluting stents to directly address the unique biology and risk factors in CKD patients.

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Authors and Affiliations

  1. Massachusetts General Hospital, Department of Medicine, Boston, MA, USA

    Shawn X. Li

  2. Icahn School of Medicine at Mount Sinai, Cardiovascular Institute, New York, NY, USA

    Usman Baber

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Correspondence to Usman Baber .

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Editors and Affiliations

  1. Einstein Medical Center/Thomas Jefferson University, Department of Medicine/Nephrology, Philadelphia, PA, USA

    Janani Rangaswami

  2. UIC/Advocate Christ Medical Center, Department of Medicine, Chicago, Il, USA

    Edgar V. Lerma

  3. Baylor University Medical Center, Baylor Heart and Vascular Hospital, Department of Internal Medicine, Texas A & M College of Medicine, Division of Cardiology, Dallas, TX, USA

    Peter A. McCullough

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Li, S.X., Baber, U. (2020). Choice of Stents and Clinical Outcomes in Patients with Chronic Kidney Disease. In: Rangaswami, J., Lerma, E., McCullough, P. (eds) Kidney Disease in the Cardiac Catheterization Laboratory . Springer, Cham. https://doi.org/10.1007/978-3-030-45414-2_7

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  • DOI: https://doi.org/10.1007/978-3-030-45414-2_7

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