Clinical Outcomes After Drug-Eluting Stent Thrombosis in Patients on Hemodialysis ― Insights From the REAL-ST Registry ―
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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BibTeX
@article{kakimoto2026clinical,
title = {{Clinical Outcomes After Drug-Eluting Stent Thrombosis in Patients on Hemodialysis ― Insights From the REAL-ST Registry ―}},
author = {Yosuke Kakimoto and Masahiro Natsuaki and Koichi Node and Hiromasa Otake and Futoshi Yamanaka and Kazunori Horie and Hiroki Shiomi and Gaku Nakazawa and Kenji Ando and Kazushige Kadota and Shigeru Saito and Takeshi Kimura and Shoichi Kuramitsu and on behalf of the REAL-ST Registry Investigators},
journal = {Circulation Journal},
year = {2026},
month = jul,
doi = {10.1253/circj.cj-26-0034},
url = {https://www.jstage.jst.go.jp/article/circj/90/8/90_CJ-26-0034/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Clinical Outcomes After Drug-Eluting Stent Thrombosis in Patients on Hemodialysis ― Insights From the REAL-ST Registry ―
AU - Yosuke Kakimoto
AU - Masahiro Natsuaki
AU - Koichi Node
AU - Hiromasa Otake
AU - Futoshi Yamanaka
AU - Kazunori Horie
AU - Hiroki Shiomi
AU - Gaku Nakazawa
AU - Kenji Ando
AU - Kazushige Kadota
AU - Shigeru Saito
AU - Takeshi Kimura
AU - Shoichi Kuramitsu
AU - on behalf of the REAL-ST Registry Investigators
PY - 2026
DA - 2026/07/24
JO - Circulation Journal
DO - 10.1253/circj.cj-26-0034
UR - https://www.jstage.jst.go.jp/article/circj/90/8/90_CJ-26-0034/_article
AB - 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.
SN - 1347-4820
SN - 1346-9843
ER -