The MASS-DAC Study.

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Presentation transcript:

The MASS-DAC Study

The MASS-DAC Study Source Charytan DM, Varma MR, Silbaugh TS, et al. Long-term clinical outcomes following drug-eluting or bare-metal stent placement in patients with severely reduced GFR: results of the Massachusetts Data Analysis Center (Mass-DAC) State Registry. Am J Kidney Dis. 2011;57(2):202–211.

Background The prevalence of chronic kidney disease (CKD) is high in patients requiring percutaneous coronary intervention (PCI). Cardiovascular event rates and mortality are higher in individuals with advanced CKD compared to individuals with preserved kidney function, possibly due to increased risks of restenosis after PCI in these patients. Drug-eluting stents markedly decrease restenosis in the general population, whether their benefits extend to patients with advanced CKD is uncertain. Patients with CKD have been under-represented in randomized trials of drug-eluting stents relative to bare-metal stents.

Aim To determine whether the use of drug-eluting stents is associated with improved outcomes in patients with severely decreased glomerular filtration rates (GFRs).

Methods

Key results • In patients with severely decreased GFR, unadjusted clinical outcomes were significantly worse. • Unadjusted mortality and MI rates were significantly lower in patients receiving drug-eluting stents, but there was no significant difference in unadjusted target-vessel revascularization rates (Fig. 1). • After propensity score matching 431 patients with a drug-eluting stent to 431 patients with a bare-metal stent, 2-year risk-adjusted mortality, MI, and target-vessel revascularization rates were 39.4% vs 37.4%, 16.0% vs 19.0%, and 13.0% vs 17.6%.

Conclusion The treatment with drug-eluting stents was associated with a modest decrease in target-vessel revascularization and both drug-eluting stents and bare-metal stents showed similar reduction in mortality or MI at 2 years. Drug-eluting stents showed a tendency toward reduced a modest reduction in target-vessel revascularization.