Although outcomes following percutaneous coronary interventions (PCI) in patients with chronic kidney disease (CKD) are superior for those who receive drug eluting stents (DES) compared to those who receive bare metal stents (BMS), perceived barriers may limit the use of DES in this population. The aim of this study is to assess the association between renal function and DES usage in real-world practice.
Data was analyzed from the CathPCI Registry of the National Cardiovascular Data Registry. All adult PCI cases between April 2009 and December 2015 were eligible for analysis. Cases were excluded if no stent was deployed or if the glomerular filtration rate (GFR) could not be calculated due to missing data. Cases were divided into the following four groups based on the patient's renal function at the time of the case:  GFR ≥ 60 mL/min/1.73m2,  GRF < 60 and ≥ 30 mL/min/1.73m2,  GFR < 30 and ≥ 15 mL/min/1.73m2, and  GFR < 15 mL/min/1.73m2 or requiring dialysis. The rate of DES usage was then compared between the groups. Subgroup analysis was conducted based on PCI indication. Differences in clinical outcomes were also compared between the groups.
A total of 3,650,333 adult PCI cases met criteria for analysis. Overall, the rate of DES usage was significantly less in the groups with moderate or severe renal dysfunction (83.0%, 79.9%, 75.6%, and 75.6%, respectively; p < 0.001). After adjusting for covariates, the odds ratio of receiving a DES compared to those with a GFR > 60 mL/min/1.73m2 decreased with declining renal function (0.894 [95% CI 0.888 - 0.900], 0.755 [0.743 - 0.766], 0.642 [0.633 - 0.652]; p < 0.001). Discrepancies in DES usage were more pronounced in the setting of ST-elevation myocardial infarction (STEMI) (70.6%, 66.5%, 58.7%, 58.0%; p < 0.001). Length of stay, in-hospital death, and the need for blood transfusion were all significantly less favorable as renal function declined.
Despite the known benefit of DES in patients with CKD undergoing PCI, usage is significantly lower in patients with moderate or severe renal dysfunction, suggesting underutilization of DES in this population. The disparity is particularly pronounced in the setting of STEMI.