Clinical Outcomes After Drug-Eluting Stent Thrombosis in Patients on Hemodialysis ― Insights From the REAL-ST Registry ―

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Abstract
Background: Chronic kidney disease is associated with an increased incidence of stent thrombosis (ST) following drug-eluting stent (DES) implantation, but the clinical outcomes after DES-ST in hemodialysis (HD) patients compared with non-HD patients have not been fully elucidated.Methods and Results: From the REAL-ST registry, we evaluated 655 patients with DES-ST, divided into 2 groups: HD group (n=59) and non-HD group (n=596). The primary endpoint was the cumulative 3-year incidence of all-cause death after the index ST event. Late ST was more prevalent in the HD group, whereas early and very late ST were common in the non-HD group. Following the index ST event, the HD group showed significantly higher 3-year incidences of all-cause death (48.2% vs. 22.9%, P=0.0005), cardiac death (33.4% vs.15.8%, P=0.003) and target lesion revascularization (TLR: 36.2% vs. 17.5%, P=0.0002) compared with the non-HD group. The cumulative 3-year incidence of recurrent ST did not differ significantly between groups (7.3% vs. 5.9%, P=0.88). After multivariable adjustment, HD remained significantly associated with an increased risk of all-cause death (adjusted hazard ratio [aHR], 1.95; 95% confidence interval [CI], 1.25–3.04; P=0.003), cardiac death (aHR, 1.75; 95% CI, 1.02–2.99; P=0.04) and TLR (aHR, 2.63; 95% CI, 1.52–4.57; P<0.001).Conclusions: Compared with non-HD patients, HD patients experienced worse clinical outcomes following their index DES-ST event.

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