Comparison of mid-term angiographical outcomes of sirolimus-eluting stent vs. everolimus-eluting stent in hemodialysis patients: impact of stent fracture or recoil

Abstract

Purpose: We compared the mid-term angiographic outcomes of de novo coronary artery lesions treated with sirolimus-eluting stents (SES) and everolimus-eluting stents (EES) in hemodialysis patients. Methods: From December 2003 to February 2012, 417 lesions in 281 hemodialysis patients were treated with SES or EES exclusively and successfully. Of these lesions, 273 lesions in 184 (65.5%) hemodialysis patients who had undergone 8-month angiographic follow-up were analysed. Results: There was no significant difference in baseline lesion and procedural characteristics except lesion length, angulated lesion and the use of intravascular ultrasound (SES vs. EES: 18.0±10.2 mm vs. 22.5±15.8 mm, p=0.01, 11.0% vs. 34.7%, p<0.001, and 26.7% vs. 56.4%, p<0.001, respectively). No significant differences were seen in the rates of restenosis and target lesion revascularization at 8-month follow-up (SES vs. EES: 27.9% vs. 20.8%, p=0.25 and 24.4% vs. 18.8%, p=0.36, respectively). However, late loss (LL) of the SES group tended to be larger than that of the EES group (0.71±0.88 mm vs. 0.52±0.79 mm, p=0.059). Moreover, stent fracture (SF) or/and stent recoil (SR), defined as axial recoil <80% in stent diameter by coronary angiography, were observed more frequently in the SES group than in the EES group (14.5% vs. 2.0%, p<0.001) and LL of the SES group with SF or/and SR was significantly larger than that of the SES group without SF and SR (1.44±1.04 mm vs. 0.58±0.78 mm, p<0.001). In contrast, LL of the SES group without SF and SR was comparable to that of the EES group without SF and SR (0.58±0.78 mm vs. 0.51±0.78, p=0.31). The histogram of LL is shown in the figure. Conclusion: EES might be superior to SES in angiographical results of hemodialysis patients due to the decreasing occurrence of SF or SR.