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Impact of chronic renal failure on effectiveness of drug-eluting stents

LETTER TO THE EDITOR

IInstituição Universidade de Caxias do Sul, Caxias do Sul, RS

IIInstituto de Cardiologia do RS - Fundação Universitária de Cardiologia, IC-FUC; Porto Alegre, RS

IIIInstituto de Pesquisa Clínica para Estudos Multicêntricos (IPCEM) do CECS-UCS, Caxias do Sul, RS

IVLiga Acadêmica de Estudos e Ações em Cardiologia da Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil

Mailing Address

Keywords: Renal insufficiency, chronic; drug-eluting stents; efficacy; follow-up studies.

The study published in volume 96(5) on the effectiveness and safety of stents in patients with chronic renal failure1; raised our interest in this topic, so we would like to ask the authors: Considering the deaths, infarctions and MACE that occurred more in the group of patients with chronic renal failure, combined to the fact that the study has not presented angiography in the follow-up study of the patients, wouldn't that be an evidence, according to the methodology of this study, that the stents are less efficient to inhibit the occurrence of death or infarctions or MACE in patients with chronic renal failure? Those patients with chronic renal failure had less pain in their angina episodes, then, how can we know exactly how many stents remained pervious, even on discharge? Another question that every reader must be asking: how many patients had worsened renal function? Thank you.

References

1. Gomes VO, Blaya P, Lasevitch R, Oliveira D, Hickmann P, Smidt L, et al. Impacto da insuficiência renal crônica na eficácia de stents farmacológicos: estudo de seguimento de longo prazo. Arq Bras Cardiol. 2011;96(5):346-52.

Reply

Thank you for your interest in our study. It is worth clarifying some important points related to the study.

The study "Impact of Chronic Renal Failure on Effectiveness of Drug-Eluting Stents: long-term follow-up study"1 was a record targeted at comparing the effectiveness and safety of drug-eluting stents in patients with chronic renal failure (CRF) compared to those without renal failure.

As it is a record, it was designed to reflect the daily medical practice; therefore, no angiographic follow-up was planned.

It is well known that patients with chronic renal failure have worse cardiovascular outcomes compared to those with preserved renal function2,3. Our study was designed to assess whether drug-eluting stents in patients with CRF have the same effectiveness observed in patients without CRF. That was demonstrated in our study, since the incidence of target lesion bypass grafting was similar in both groups (4.8% vs. 5.6%, p = 0.7, CRF group and non-CRF group, respectively).

As expected, patients with chronic renal failure had worse cardiovascular outcomes, which was modified with the use of drug-eluting stents. Finally, the study aimed to evaluate the evolution of renal function of patients included, so these data are not available.

We hope to have clarified the issues raised by the colleagues.

Sincerely,

Vitor Gomes

References

Carta-resposta

Agradecemos o interesse dos autores em nosso estudo e queremos esclarecer alguns pontos importantes quanto a ele.

O estudo "Impacto da insuficiência renal crônica na eficácia e segurança de stents farmacológicos: seguimento de longo prazo"1 foi um registro que teve como objetivo comparar a eficácia e a segurança dos stents farmacológicos em pacientes com Insuficiência Renal Crônica (IRC) em comparação àqueles sem insuficiência renal.

Por ser um registro, foi desenhado para refletir a prática médica diária; dessa forma, não foi planejado seguimento angiográfico.

Já é bem conhecido que pacientes com insuficiência renal crônica apresentam piores desfechos cardiovasculares quando comparados àqueles com função renal preservada2,3. O que nosso estudo se propôs foi avaliar se os stents farmacológicos apresentam nos pacientes com IRC a mesma eficácia observada nos pacientes sem IRC. Isso ficou demonstrado em nosso estudo, uma vez que a incidência de revascularização de lesão alvo foi semelhante nos dois grupos (4,8% vs. 5,6%, p = 0,7; grupo IRC e não IRC, respectivamente).

Como esperado, os pacientes com insuficiência renal crônica apresentaram piores desfechos cardiovasculares, o que não foi modificado com o uso de stents farmacológicos. Por fim, o estudo não teve como objetivo avaliar a evolução da função renal dos pacientes incluídos; portanto, esses dados não estão disponíveis.

Esperamos ter esclarecido as questões levantadas pelos colegas.

Atenciosamente

Vitor Gomes

Referências

1. Gomes VO, Blaya P, Lasevitch R, Oliveira D, Hickmann P, Smidt L, et al. Impacto da insuficiência renal crônica na eficácia de stents farmacológicos: estudo de seguimento de longo prazo. Arq Bras Cardiol. 2011;96(5):346-52.

  • 1. Gomes VO, Blaya P, Lasevitch R, Oliveira D, Hickmann P, Smidt L, et al. Impacto da insuficiência renal crônica na eficácia de stents farmacológicos: estudo de seguimento de longo prazo. Arq Bras Cardiol. 2011;96(5):346-52.
  • 2 Reddan DN, Szczech LA, Tuttle RH, Shaw LK, Jones RH, Schwab SJ, et al. Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol. 2003;14(9):2373-80.
  • 3 McCullough PA, Soman SS, Shah SS, Smith ST, Marks KR, Yee J, et al. Risks associated with renal dysfunction in patients in the coronary care in the coronary. J Am Coll Cardiol. 2000;36(3):679-84.
  • Impact of chronic renal failure on effectiveness of drug-eluting stents

    Eduardo Maffini da RosaI,II,III,IV; Laís MerzoniI; Marcelo Nicola BranchiI
  • Publication Dates

    • Publication in this collection
      08 Feb 2012
    • Date of issue
      Jan 2012
    Sociedade Brasileira de Cardiologia - SBC Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil, Fax: +55 21 3478-2770 - São Paulo - SP - Brazil
    E-mail: revista@cardiol.br