Independent predictors of restenosis after percutaneous coronary revascularization in haemodialysis patients

Hase, Hiroki; Nakamura, Masato; Joki, Nobuhiko; Tsunoda, Taro; Nakamura, Ryoichi; Saijyo, Tomokatsu; Morishita, Masaki; Yamaguchi, Tetsu

doi:10.1093/ndt/16.12.2372

Cited by 28 publications

(19 citation statements)

References 19 publications

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“…Evidence in the literature would support this, with a number of studies reporting the poor prognosis associated with angiographically severe CAD and death or major adverse cardiac event within 1 year of dialysis (31,32). The same group has also demonstrated improved long-term outcomes in dialysis patients with CAD after revascularization (33). The small but significant incidence of coronary events postintervention will require further study, which we are currently undertaking.…”

Section: Discussionmentioning

confidence: 89%

“…The small but significant incidence of coronary events postintervention will require further study, which we are currently undertaking. Within the current renal literature, there are studies with small numbers of mainly symptomatic patients with restenosis rates of 22% to 33% up to 1 year after percutaneous intervention (34,35), and more historical reports of restenosis rates of 60% to 75% up to 1 year after balloon angioplasty (33,36).…”

Section: Discussionmentioning

confidence: 99%

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Cardiac Survival after Pre-emptive Coronary Angiography in Transplant Patients and Those Awaiting Transplantation

Kumar

Baker

Chan

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Recent interest has focused on wait listing patients without pretreating coronary artery disease to expedite transplantation. Our practice is to offer coronary revascularization before transplantation if indicated. Between 2006 and 2009, 657 patients (427 men, 230 women; ages, 56.5 Ϯ 9.94 years) underwent pretransplant assessment with coronary angiography. 573 of 657 (87.2%) patients were wait listed; 247 of 573 (43.1%) patients were transplanted during the follow-up period, 30.09 Ϯ 11.67 months. Design, setting, participants, & measurementsResults Patient survival for those not wait listed was poor, 83.2% and 45.7% at 1 and 3 years, respectively. In wait-listed patients, survival was 98.9% and 95.3% at 1 and 3 years, respectively. 184 of 657 (28.0%) patients were offered revascularization. Survival in patients (n ϭ 16) declining revascularization was poor: 75% survived 1 year and 37.1% survived 3 years. Patients undergoing revascularization followed by transplantation (n ϭ 51) had a 98.0% and 88.4% cardiac event-free survival at 1 and 3 years, respectively. Cardiac event-free survival for patients revascularized and awaiting deceased donor transplantation was similar: 94.0% and 90.0% at 1 and 3 years, respectively. ConclusionsOur data suggest pre-emptive coronary revascularization is not only associated with excellent survival rates in patients subsequently transplanted, but also in those patients waiting on dialysis for a deceased donor transplant.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Cardiac Survival after Pre-emptive Coronary Angiography in Transplant Patients and Those Awaiting Transplantation

Kumar

Baker

Chan

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…A previous study reported that rotational atherectomy prior to coronary BMS implantation reduced the restenosis rate of the severely calcified coronary lesions. 11) In the present study, if predilatation was possible with a balloon, we implanted SESs even in severely calcified lesions without prior rotational atherectomy. However, the results of the present study suggest that rotational atherectomy prior to coronary SES implantation may improve the clinical and angiographic outcome in HD patients with coronary artery disease, especially in patients with severely calcified coronary lesions.…”

Section: Discussionmentioning

confidence: 93%

“…11) However, clinical outcome after coronary intervention of patients with HD remains poor in comparison with the non-HD population in the BMS era.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Long-Term Clinical Outcome After Sirolimus-Eluting Stent Implantation in Patients With and Without Hemodialysis

Sasao¹,

Hotta

Maeda

et al. 2007

Int. Heart J.

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SUMMARYPoor clinical outcomes for hemodialysis (HD) patients compared to non-HD patients after coronary intervention have been reported. Although coronary intervention using sirolimus-eluting stents (SESs) might be expected to reduce restenosis in HD patients, little is known about the efficacy of the SESs. The purpose of the present study was to compare the clinical and angiographic outcomes of HD patients with non-HD patients after SES implantation. The study population consisted of 170 consecutive patients (234 lesions) who had undergone successful coronary SES implantation. The patients were classified into 2 groups, an HD group (18 patients, 27 lesions) and a non-HD group (152 patients, 207 lesions). The incidence of any clinical event was significantly higher in the HD group than in the non-HD group (50.0% versus 12.5%, P < 0.0001). Target lesion revascularization was necessary in 6 patients (33.3%) in the HD group and in 7 patients (4.6%) in the non-HD group (P < 0.0001). The Cox proportional-hazards regression model on cardiac events identified HD patients (P = 0.0301, hazard ratio = 2.704) as an explanatory factor. Moreover, the Cox proportional-hazards regression model on target lesion revascularization identified HD (P = 0.0004, hazard ratio = 6.921) and in-stent restenosis lesion (P = 0.0293, hazard ratio = 3.323) as explanatory factors. The present study suggests that compared with non-HD patients, HD patients with coronary artery disease treated by SESs have a poorer clinical outcome. (Int Heart J 2007; 48: 689-700) Key words: Sirolimus-eluting stents, Hemodialysis, Clinical outcome HEMODIALYSIS (HD) patients are well known to be a high risk population for coronary artery disease. 1) Moreover, poor clinical outcomes compared to non-HD patients after coronary intervention have been reported. 2,3) Previous studies of sirolimus-eluting stents (SESs) compared with bare-metal stents (BMSs) in coronary artery disease have demonstrated a reduction in the incidence of cardiac events related to recurrent ischemia and lower rates of angiographic restenosis. 4-7)From the

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“…End-stage renal disease did not increase the risk of restenosis after provisional stenting in this series. Coronary stenting also reduced the incidence of major adverse cardiac events as well as the restenosis rate in hemodialysis patients (43). In a retrospective analysis of 3334 patients, Rubenstein and colleagues found that the increase of stent utilization between 1994 and 1997 was associated with an increase in procedural success and a reduction in in-hospital major coronary events, especially in people with minor renal dysfunction (31).…”

Section: Therapeutic Options For Patients With Renal Insufficiency Anmentioning

confidence: 99%

How Does Minor Renal Dysfunction Influence Cardiovascular Risk and the Management of Cardiovascular Disease?

Pinkau¹,

Hilgers²,

Veelken³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. This review focuses on the association between mild renal insufficiency (stage 2 and 3 of chronic kidney disease) and cardiovascular disease and discusses therapeutic options. Although the association of chronic renal insufficiency and cardiovascular risk was first shown in patients with end-stage renal disease, even minor renal dysfunction is now established as an independent risk for atherosclerotic cardiovascular disease. The association has been established in patients with a high cardiovascular risk but also in the general population. Treatment with angiotensin-converting enzyme inhibitors and statins can reduce cardiovascular morbidity and mortality in patients with renal insufficiency. Coronary revascularization improves the prognosis in patients with minor renal dysfunction, but there is still an underutilization of coronary revascularization procedures in people with renal insufficiency. The use of coronary stenting has now reduced the incidence of restenosis in these patients, and there is hope that the development of new devices will improve the prognosis in patients with renal insufficiency as well. Nevertheless, people with cardiovascular disease and renal insufficiency die significantly more often than people without renal insufficiency independent of prior successful treatment. Further investigations should focus on the causes of and possible preventive interventions for the staggering cardiovascular risk in the everincreasing number of people with minor renal dysfunction. Cardiovascular disease is common in patients with renal insufficiency. The association between renal insufficiency and cardiovascular disease was first shown in patients with end-stage renal disease, whose cardiovascular mortality exceeds that of patients without renal disease by a factor of 20 to 40. Even in adolescents with end-stage renal disease, there is a staggering cardiovascular risk (1). However, the impact of renal insufficiency on the development of atherosclerotic cardiovascular disease probably begins with minor renal dysfunction (2). Until recently, there was little evidence linking minor renal dysfunction (stage 2 and 3 of chronic kidney disease) to an increased cardiovascular risk. Here, we review the evidence and therapeutic options. Renal Insufficiency in People Not Selected for Cardiovascular Risk FactorsPatients with varying degrees of renal insufficiency have a predisposition to accelerated atherosclerosis and its consequences even in the absence of traditional cardiovascular risk factors (3). One of the first studies to assess minor renal dysfunction as a predictor of cardiovascular risk in a general population was the Framingham Heart Study (4); 6233 individuals with a mean age of 54 yr were followed for a mean of 15 yr. Minor renal dysfunction was present in 8% of women and 9% of men at baseline and was associated with a 40% greater all-cause mortality in men but not in women. However, there were only trends but no significant association between mild renal insufficiency and future cardiovascula...

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Independent predictors of restenosis after percutaneous coronary revascularization in haemodialysis patients

Cited by 28 publications

References 19 publications

Cardiac Survival after Pre-emptive Coronary Angiography in Transplant Patients and Those Awaiting Transplantation

Cardiac Survival after Pre-emptive Coronary Angiography in Transplant Patients and Those Awaiting Transplantation

Comparison of Long-Term Clinical Outcome After Sirolimus-Eluting Stent Implantation in Patients With and Without Hemodialysis

How Does Minor Renal Dysfunction Influence Cardiovascular Risk and the Management of Cardiovascular Disease?

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