Hemodialysis is an Independent Predictor of Coronary In-stent Restenosis after Paclitaxel Eluting Stent Implantation

Abstract

Objective A drug eluting stent is often used for high-risk patients with complications such as diabetes mellitus (DM) and hemodialysis (HD), however the factors to predict restenosis after paclitaxel-eluting stent (PES) placement have not been reported to date. Methods Between May 2007 and August 2009, 165 consecutive patients (231 stents) received PES in our hospital. Stent diameter and length were determined by the use of intravascular ultrasound (IVUS). All patients continued to take 2 types of anti-platelet agents (aspirin and Clopidogrel or Ticlopidine). Ninety percent of the subjects received a follow-up coronary angiogram 6 months later. Results Underlying diseases were hypertension in 75%, hyperlipidemia in 78% and DM in 60% (15% on insulin), and 14% of the subjects received HD. Eighty-three percent of the patients had orally taken Statin, 85% ACE/ARB and 68% had beta blockers. Mean length and diameter of PES were 21.6 ± 7.2 mm and 2.9 ± 0.3 mm, respectively. Target lesion revascularization (TLR) rate 6 months after PES placement was 14.6% overall. In HD patients TLR was 43%, hypertension 15.0%, hyperlipemia 12.4%, DM with oral medication 12.5%, DM with insulin 12.0%, respectively. In multivariate analysis, HD was an independent risk factor for TLR (p=0.0001, OR: 6.61, 95% C.I.: 2.34-18.6). Conclusion HD had the greatest influence on TLR after PES even though risk factors were well controlled. It is necessary to develop new PCI techniques and stents that are useful for HD patients.

Long-Term Survival and Repeat Coronary Revascularization in Dialysis Patients After Surgical and Percutaneous Coronary Revascularization With Drug-Eluting and Bare Metal Stents in the United States

“…26 Recent data from a multi-center study in Japan using sirolimus-eluting stents emphasize the more than 2-fold higher rates of target lesion revascularization and more than 5-fold greater risk of cardiac mortality after adjustment for baseline characteristics and procedural characteristics in hemodialysis versus non-dialysis patients. 29 Hemodialysis has been consistently shown to be an independent risk factor for in-stent restenosis following placement of stents eluting sirolimus 28 and paclitaxel, 30 both first generation DES platforms. Finally, the pathophysiological factors underlying the process of accelerated atherosclerosis also predispose to stent thrombosis, a phenomenon of particular concern with DES, 16,31 which could also result in higher rates of myocardial infarction and mortality.…”

Mechanism of Edge Restenosis After Drug-Eluting Stent Implantation

“…Diabetes mellitus and chronic renal failure (CRF) were significantly more prevalent in the restenosis group than in the non-restenosis group, which was in accordance with previous reports. 15, 16 Hypertension was also more prevalent in the restenosis group. Baseline clinical and angiographic characteristics of the edge restenosis and the in-stent restenosis groups are shown in Table 2 and Table 3.…”

Coronary Revascularization in Patients with CKD Stage 5D: Pragmatic Considerations

“…25,[38][39][40] Hemodialysis has been identified as an independent predictor of repeat target lesion revascularization after both sirolimus-(19.4% versus 6.6%; P,0.001) 31 and paclitaxel-eluting (odds ratio, 6.6; 95% CI, 2.34 to 18.6) stents 41 ; the newer generation of everolimus-eluting stents likely has lower in-stent restenosis rates. 42 Hemodialysis was an independent predictor of major adverse cardiovascular outcomes at 2 years after DES among patients with CKD 5D versus patients without CKD driven by higher mortality (12% versus 0.6%) and target vessel revascularization (24% versus 9%) rates.…”