Clinical outcomes after stent thrombosis in patients with hemodialysis: from the Real-ST registry

Background Chronic kidney disease has been reported to be associated with an increased incidence of stent thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Renal impairment is also linked to a gradual elevation in residual platelet reactivity, enhancing risks for cardiovascular events, especially in patients with hemodialysis (HD). However, the clinical outcomes after DES thrombosis in patients with HD compared with non-HD have not been fully elucidated. Purpose The purpose of the current analysis was to assess the clinical outcomes in patients with HD after treatment for ST following DES implantation. Methods From the REAL-ST (Retrospective Multicenter Registry of ST After First- and Second-Generation Drug-Eluting Stent Implantation) registry, this study evaluated 655 patients with DES thrombosis. Patients were divided into two groups: the HD group (n=59) and the non-HD groups (n=596). The primary endpoint was the cumulative 3-year incidence of all-cause death after the index ST events. Target lesion revascularization (TLR) and recurrent stent thrombosis (RST) were also assessed. Results With regard to the timing of ST, late ST was more frequently observed in the HD group (55.9％ vs. 9.7％, P=0.001), while early ST and very late ST were less likely to occur in the HD group than in the non-HD group (20.3% vs. 41.8%, P<0.0001; 23.7% vs. 48.5%, P=0.0003, respectively). Regarding clinical presentation at the time of ST, non-ST-segment elevation myocardial infarction, unstable angina and cardiac arrest were more frequently observed in the HD group than in the non-HD group. The median follow-up duration from the index procedure was 3.2 years (interquartile range: 2.0-5.2 years). The HD group showed significantly higher 3-year incidences of all-cause death (48.2% vs. 22.9%, P=0.007) and TLR (36.2% vs. 17.5%, P=0.0003) compared with the non-HD group after the index ST event. Cumulative 3-year incidence of RST was not significantly different between the HD and the non-HD groups (7.3％ vs. 5.9％, P=0.88). After adjustment for baseline differences, the increased risks in the HD group relative to the non-HD group remained significant for all-cause death (adjusted hazard ratio, 1.85 [95%CI 1.19-2.88]; P=0.007) and TLR (adjusted hazard ratio, 2.62 [95%CI 1.62-4.55]; P=0.0006). Conclusion Patients with HD were associated with significantly higher risks of all-cause death and TLR after the index DES thrombosis event.