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Coronary stents not harmful for patients with metal allergy
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A history of metal allergy may not prevent patients with coronary artery disease from undergoing coronary stent implantation.
“Most interventional cardiologists will, at some stage, have to decide whether to place a coronary stent in a patient with a history of skin allergy to one of the metal components, most commonly nickel,” Rajiv Gulati, MD, PhD, of the Mayo Clinic in Rochester, Minn., said in a press release. “Our study found no evidence of an increased risk of heart attack, death or restenosis … in patients who reported themselves to be allergic to metal prior to implantation.”
The researchers conducted a retrospective evaluation of early- and long-term clinical outcomes in 29 patients with a history metal allergy to nickel (n=26) and chromium (n=9). All subsequently underwent coronary stent implantation.
Compared with 250 matched control nonallergic patients, data revealed no statistically significant differences in in-hospital death (0% vs. 0%), 30-day mortality (3% vs. 0%; P=.53) and MI (3% vs. 4%; P=.71). Additionally, results showed similar rates of 4-year mortality (12% vs. 13%), target lesion revascularization (TLR; 13% vs. 17%; P=.54) or a composite of mortality, MI and TLR (24% vs. 34%; P=.2). Repeat angiography in 12 of the 29 patients with a history of allergy showed binary restenosis rates of 27% in bare metal stents and 0% in drug-eluting stents. Mean diameter in-stent restenosis was 35% and 8%, respectively.
No change in markers of allergic response, including circulating eosinophil and lymphocyte counts, were discovered after stent implantation.
“We do not routinely test for nickel allergy, so we don’t know how many people coming to the cath lab have this problem,” Gulati said. “Still our findings would suggest that the mechanism of skin reaction to metal exposure might differ from that within the arterial wall.”
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