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Lao Y, Chen K, Feng L, Yuan Y, Zhang J, Zhang L, Huang X, Li M, Wu Z, Bin J, Liao Y. Delayed PCI is not beneficial for STEMI patients with impaired renal function: a retrospective cohort study. BMC Cardiovasc Disord 2023; 23:263. [PMID: 37208590 DOI: 10.1186/s12872-023-03271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Preexisting impaired renal function (IRF) and contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) are important prognostic parameters, but it is unknown whether delayed PCI is still beneficial for STEMI patients with IRF. METHODS A retrospective single-center cohort study was performed in 164 patients who presented at least 12 h after symptom onset, and were diagnosed with STEMI and IRF. They were assigned to two groups to receive PCI plus optimal medical therapy (OMT) and OMT alone respectively. Clinical outcomes at 30 days and 1 year were compared between two groups, and hazard ratio for survival was analyzed using Cox regression model. A power analysis demanded 34 patients in each group to produce a power of 90% and a P value of 0.05. RESULTS The 30-day mortality was significantly lower in PCI group (n = 126) than in non-PCI group (n = 38) (11.1% versus 28.9%, P = 0.018), while there was no significant difference in the 1-year mortality and incidence of cardiovascular comorbidities between the two groups. Cox regression analysis showed that patients with IRF didn't benefit from receiving PCI on survival rate (P = 0.267). CONCLUSIONS Delayed PCI is not beneficial on one-year clinical outcomes for STEMI patients with IRF.
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Affiliation(s)
- Yi Lao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Heart Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong province, China
| | - Kaitong Chen
- Cardiovascular Department, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong Province, China.
| | - Li Feng
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Yong Yuan
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Jin Zhang
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Liting Zhang
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Xuansheng Huang
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Mingxing Li
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Zidi Wu
- Department of Cardiology, Zhongshan Hospital, Sun Yat-sen University, Zhongshan City, Guangdong province, China
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Heart Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong province, China
| | - Yulin Liao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Heart Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong province, China.
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Limpijankit T, Chandavimol M, Srimahachota S, Kanoksilp A, Jianmongkol P, Siriyotha S, Thakkinstian A, Buddhari W, Sansanayudh N. Dose-dependent effect of impaired renal function on all-cause mortality in patients following percutaneous coronary intervention. Clin Cardiol 2022; 45:882-891. [PMID: 35758306 PMCID: PMC9346964 DOI: 10.1002/clc.23877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To determine the risk prediction of various degrees of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention (PCI). Background Patients with chronic kidney disease (CKD) are at high risk of all‐cause mortality after PCI. However, there are less data of various degrees of impaired renal function to predict those risks. Methods This was a subgroup analysis of nationwide PCI registry of 22 045 patients. Patients were classified into six CKD stages according to preprocedure estimated glomerular filtration rate (eGFR) (ml/min/1.73 m2): I (≥90), II (60−89), III (30−59), IV (15−29), or V (<15) without or with dialysis. Baseline clinical and angiographic characteristics were compared among patients in each stage. One‐year all‐cause mortality was reported with risk prediction based on CKD stages and other risk factors. Results Patients with CKD stage I−V without and with on dialysis were found in 26.9%, 40.8%, 23.2%, 3.9%, 1.5%, and 3.7%, respectively. PCI procedural success and complication rates ranged from 94.0% to 96.2% and 2.8% to 6.1%, respectively. One‐year overall survival among CKD stages I−V was 96.3%, 93.1%, 84.4%, 65.2%, 68.0%, and 69.4%, respectively (p < .001 by log‐rank test). After adjusting covariables, the hazard ratios of all‐cause mortality for CKD stages II−V as compared to stage I by multivariate Cox regression analysis were 1.5, 2.6, 5.3, 5.9, and 7.0, respectively, (p < .001). Conclusion Among patients undergoing PCI, lower preprocedure eGFR is associated in a dose‐dependent effect with decreased 1‐year survival. This finding may be useful for risk classification and to guide decision‐making.
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Affiliation(s)
- Thosaphol Limpijankit
- Department of Medicine, Division of Cardiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mann Chandavimol
- Department of Medicine, Division of Cardiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphot Srimahachota
- Department of Medicine, Division of Cardiovascular Diseases, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Anek Kanoksilp
- Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Poj Jianmongkol
- Department of Cardiology, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | - Sukanya Siriyotha
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wacin Buddhari
- Department of Medicine, Division of Cardiovascular Diseases, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nakarin Sansanayudh
- Department of Internal Medicine, Cardiology Unit, Pharmongkutklao Hospital, Bangkok, Thailand
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Chandra N, Fryer M, Nadra I, Wood DA, Webb JG, Ding L, Hardiman S, Fung A, Aymong E, Chan A, Hodge S, Horgan K, Levin A, Robinson SD, Della Siega A, Iqbal MB. The Impact of Pre-Procedural Renal Impairment on Outcomes Following Percutaneous Coronary Intervention: An Analysis of 45,287 Patients From the British Columbia Cardiac Registry. Heart Lung Circ 2022; 31:647-657. [PMID: 35063378 DOI: 10.1016/j.hlc.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/25/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Renal disease confers a strong independent risk for morbidity and mortality after percutaneous coronary intervention (PCI). We evaluated the relationship between baseline pre-procedural renal function and outcomes following PCI. METHODS We examined 45,287 patients who underwent PCI in British Columbia. We evaluated all-cause mortality and target vessel revascularisation (TVR) at 2 years. Pre-procedural renal impairment was categorised by creatinine clearance (CrCl, mL/min): CrCl≥90 (n=14,876), 90>CrCl≥60 (n=10,219), 60>CrCl≥30 (n=14,876), 30>CrCl≥0 (n=2,594) and dialysis (n=579). RESULTS Declining CrCl values less than 60 mL/min were progressively associated with greater mortality: 60>eGFR≥30 (HR=2.01, 95% CI 1.71-2.37, p<0.001); 30>eGFR≥0 (HR=4.10, 95% CI 3.39-4.95, p<0.001); and dialysis (HR=6.22, 95% CI 5.07-7.63, p<0.001). A reduction in eGFR was not associated with TVR in non-dialysis patients. However, dialysis was a strong independent predictor for TVR (HR=1.69, 95% CI 1.37-2.08, p<0.001). This was confirmed in propensity-matched analyses where, dialysis was strongly associated with TVR (HR=1.53, 95% CI 1.24-1.89, p<0.001). This association was consistently seen in stratified analyses for diabetic versus non-diabetic patients; stent length >30 mm versus <30 mm; stent diameter >3 mm versus <3 mm; and receipt of bare metal stents versus drug-eluting stents. CONCLUSIONS This study indicates the association with declining renal function and mortality in patients undergoing PCI. Whilst renal disease was not associated with increased TVR in non-dialysis patients, dialysis-dependence was a strong independent predictor for increased TVR.
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Affiliation(s)
- Navin Chandra
- Victoria Heart Institute Foundation, Victoria, BC, Canada; Royal Jubilee Hospital, Victoria, BC, Canada
| | - Michael Fryer
- Victoria Heart Institute Foundation, Victoria, BC, Canada; Royal Jubilee Hospital, Victoria, BC, Canada
| | - Imad Nadra
- Victoria Heart Institute Foundation, Victoria, BC, Canada; Royal Jubilee Hospital, Victoria, BC, Canada
| | | | | | - Lillian Ding
- Provincial Health Services Authority, Vancouver, BC, Canada
| | - Sean Hardiman
- Provincial Health Services Authority, Vancouver, BC, Canada
| | - Anthony Fung
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Eve Aymong
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Albert Chan
- Royal Columbian Hospital, Vancouver, BC, Canada
| | | | - Kevin Horgan
- Provincial Health Services Authority, Vancouver, BC, Canada
| | | | - Simon D Robinson
- Victoria Heart Institute Foundation, Victoria, BC, Canada; Royal Jubilee Hospital, Victoria, BC, Canada
| | - Anthony Della Siega
- Victoria Heart Institute Foundation, Victoria, BC, Canada; Royal Jubilee Hospital, Victoria, BC, Canada
| | - M Bilal Iqbal
- Victoria Heart Institute Foundation, Victoria, BC, Canada; Royal Jubilee Hospital, Victoria, BC, Canada.
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Dunn AN, Huded C, Raymond R, Lincoff AM, Bajzer C, Kapadia S, Ellis SG. Successful modeling of long term outcomes in end-stage renal disease patients undergoing percutaneous coronary intervention with drug-eluting stents. Catheter Cardiovasc Interv 2021; 98:208-214. [PMID: 33913614 DOI: 10.1002/ccd.29707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study is to identify and model risk factors for major adverse cardiac events (MACE) and all-cause mortality among patients with ESRD treated with PCI using DES. BACKGROUND Patients with end-stage renal disease (ESRD) have poor long-term outcomes after percutaneous coronary intervention (PCI) compared with non-ESRD patients. However, there is a paucity of literature regarding risk factors associated with outcomes of ESRD patients after PCI with drug-eluding stents (DES). METHODS This retrospective cohort study includes all patients with ESRD who underwent first-time PCI with DES at a single, high-volume hospital between 1/1/2005 and 12/31/2015, with follow-up through 9/1/2019. Primary outcomes were MACE (cardiac death, myocardial infarction, or unplanned revascularization) and all-cause mortality. RESULTS Five-year MACE was 83.0% and five-year morality was 77.9% in patients with ESRD (n = 285). Among ESRD patients, factors independently associated with MACE were C-reactive peptide level, SYNTAX score, peripheral vascular occlusive disease, hemoglobin, and treatment of a restenotic lesion (c-index = 0.66). Factors independently associated with mortality in ESRD patients were age, SYNTAX score, non-use of statins at baseline, insulin-dependent diabetes, chronic obstructive pulmonary disease (COPD), peripheral vascular occlusive disease, and platelet count (c-index = 0.65). CONCLUSIONS Despite relatively poor 1-and 5-year outcomes among ESRD patients after PCI, risk of MACE and mortality among this cohort can be successfully modelled, which meaningfully informs clinicians regarding management of ESRD patients with coronary artery disease (CAD). Further investigations are necessary to determine whether or not outcomes might be improved through risk profile modification.
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Affiliation(s)
- Aaron N Dunn
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Chetan Huded
- Saint Luke's Mid America Heart Institute, Kansas city, Missouri, USA
| | - Russell Raymond
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - A Michael Lincoff
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher Bajzer
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Hansrivijit P, Chen YJ, Lnu K, Trongtorsak A, Puthenpura MM, Thongprayoon C, Bathini T, Mao MA, Cheungpasitporn W. Prediction of mortality among patients with chronic kidney disease: A systematic review. World J Nephrol 2021; 10:59-75. [PMID: 34430385 PMCID: PMC8353601 DOI: 10.5527/wjn.v10.i4.59] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/11/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common medical condition that is increasing in prevalence. Existing published evidence has revealed through regression analyses that several clinical characteristics are associated with mortality in CKD patients. However, the predictive accuracies of these risk factors for mortality have not been clearly demonstrated. AIM To demonstrate the accuracy of mortality predictive factors in CKD patients by utilizing the area under the receiver operating characteristic (ROC) curve (AUC) analysis. METHODS We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through January 2021. Studies were included based on the following criteria: (1) Study nature was observational or conference abstract; (2) Study populations involved patients with non-transplant CKD at any CKD stage severity; and (3) Predictive factors for mortality were presented with AUC analysis and its associated 95% confidence interval (CI). AUC of 0.70-0.79 is considered acceptable, 0.80-0.89 is considered excellent, and more than 0.90 is considered outstanding. RESULTS Of 1759 citations, a total of 18 studies (n = 14579) were included in this systematic review. Eight hundred thirty two patients had non-dialysis CKD, and 13747 patients had dialysis-dependent CKD (2160 patients on hemodialysis, 370 patients on peritoneal dialysis, and 11217 patients on non-differentiated dialysis modality). Of 24 mortality predictive factors, none were deemed outstanding for mortality prediction. A total of seven predictive factors [N-terminal pro-brain natriuretic peptide (NT-proBNP), BNP, soluble urokinase plasminogen activator receptor (suPAR), augmentation index, left atrial reservoir strain, C-reactive protein, and systolic pulmonary artery pressure] were identified as excellent. Seventeen predictive factors were in the acceptable range, which we classified into the following subgroups: predictors for the non-dialysis population, echocardiographic factors, comorbidities, and miscellaneous. CONCLUSION Several factors were found to predict mortality in CKD patients. Echocardiography is an important tool for mortality prognostication in CKD patients by evaluating left atrial reservoir strain, systolic pulmonary artery pressure, diastolic function, and left ventricular mass index.
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Affiliation(s)
- Panupong Hansrivijit
- Department of Internal Medicine, UPMC Pinnacle, Harrisburg, PA 17104, United States
| | - Yi-Ju Chen
- Department of Internal Medicine, UPMC Pinnacle, Harrisburg, PA 17104, United States
| | - Kriti Lnu
- Department of Internal Medicine, UPMC Pinnacle, Harrisburg, PA 17104, United States
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, IL 60202, United States
| | - Max M Puthenpura
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA 19129, United States
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, United States
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
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Zafrir B, Leviner DB, Saliba W, Sharoni E. Prognostic Interplay of Chronic Kidney Disease, Anemia, and Diabetes in Coronary Bypass Surgery. Ann Thorac Surg 2020; 111:94-101. [PMID: 32561312 DOI: 10.1016/j.athoracsur.2020.04.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/01/2020] [Accepted: 04/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic kidney disease and anemia often coexist and may accompany diabetes; all 3 conditions are associated with worse cardiovascular outcomes. This study investigated the prognostic implications of anemia and chronic kidney disease for mortality among patients undergoing coronary artery-bypass grafting surgery and examined whether outcomes are related to the presence of diabetes. METHODS This retrospective study included 1180 patients undergoing coronary artery-bypass grafting. Long-term mortality (mean follow-up, 8.6 ± 4.2 years) was examined in relation to preoperative anemia, chronic kidney disease, and diabetes. Prognostic interplay of the 3 risk factors was evaluated. RESULTS Chronic kidney disease, anemia, and diabetes (20%, 25%, and 43% of patients, respectively), were independent risk predictors for mortality. Compared with patients with neither chronic kidney disease nor anemia, the adjusted hazard ratios (HRs) for mortality were 1.87 (95% confidence interval [CI], 1.35 to 2.59) in chronic kidney disease only, 1.75 (95% CI, 1.30 to 2.35) in anemia only, and 2.69 (95% CI, 1.91 to 3.78) in patients with both conditions. The pattern of association of chronic kidney disease and anemia with mortality was similar in patients with and without diabetes. However, mortality risk was higher in patients with diabetes in each risk category-neither chronic kidney disease nor anemia: HR, 1.69 (95% CI, 1.20 to 2.39) vs HR, 1 (reference); chronic kidney disease only: HR, 2.68 (95% CI, 1.59 to 4.52) vs HR, 2.10 (95% CI, 1.38 to 3.20); anemia only: HR, 2.73 (95% CI, 1.83 to 4.07) vs HR, 1.94 (95% CI, 1.23 to 3.08); and both chronic kidney disease and anemia: HR, 4.44 (95% CI, 2.88 to 6.85) vs HR, 2.72 (95% CI, 1.58 to 4.69). CONCLUSIONS In patients undergoing coronary artery-bypass grafting, anemia and chronic kidney disease have significant prognostic implications for long-term mortality. Their effect on mortality was cumulatively associated with adverse impacts of diabetes.
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Affiliation(s)
- Barak Zafrir
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel.
| | - Dror B Leviner
- Department of Cardiothoracic Surgery, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Erez Sharoni
- Department of Cardiothoracic Surgery, Lady Davis Carmel Medical Center, Haifa, Israel
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Cilia L, Sharbaugh M, Marroquin OC, Toma C, Smith C, Thoma F, Lee J, Mulukutla SR. Impact of Chronic Kidney Disease and Anemia on Outcomes After Percutaneous Coronary Revascularization. Am J Cardiol 2019; 124:851-856. [PMID: 31375241 DOI: 10.1016/j.amjcard.2019.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/20/2019] [Accepted: 06/10/2019] [Indexed: 12/14/2022]
Abstract
Few studies have evaluated outcomes after percutaneous coronary intervention (PCI) in patients with both anemia (hemoglobin < 12 g/dl in women; <13 in men) and chronic kidney disease (CKD, estimated glomerular filtration rate < 60 ml/min/1.73 m2). Patients with coronary artery disease who underwent PCI in our health system from 2010 to 2018 were included (n = 10,756), excluding those with ST-elevation myocardial infarction or shock. We evaluated the individual and combined effects of anemia and CKD on outcomes. Five-year mortality was highest in the cohort with both anemia and CKD and lowest in those with neither. After multivariate analysis, with the group with neither anemia nor CKD as a reference, the adjusted hazard ratio for mortality was 1.68 (95% confidence interval [CI] 1.45 to 1.95, p <0.001) for those with anemia alone, 1.33 (95% CI 1.15 to 1.53, p <0.001) for those with CKD alone, and 2.83 (95% CI 2.49 to 3.22, p <0.001) for those with both anemia and CKD. With respect to readmission and reintervention, similar tends were observed, with patients with both CKD and anemia having the highest risk for these outcomes. In conclusion, the combined effects of anemia and CKD on outcomes post-PCI appear to be worse than either of their effects individually.
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Affiliation(s)
- Lindsey Cilia
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Conrad Smith
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joon Lee
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Trans-radial percutaneous coronary intervention for patients with severe chronic renal insufficiency and/or on dialysis. Heart Vessels 2019; 34:1412-1419. [DOI: 10.1007/s00380-019-01387-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/15/2019] [Indexed: 12/16/2022]
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9
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Beneficial effect of statins in patients receiving chronic hemodialysis following percutaneous coronary intervention: A nationwide retrospective cohort study. Sci Rep 2018; 8:9692. [PMID: 29946155 PMCID: PMC6018797 DOI: 10.1038/s41598-018-27941-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 06/11/2018] [Indexed: 12/24/2022] Open
Abstract
The cardiovascular diseases are the leading cause of mortality in end-stage renal disease (ESRD) patients. However, roles of statins are still controversial in dialysis-dependent ESRD patients regardless of having proven coronary artery occlusive disease. The aim of this study was to examine the benefit of statin following percutaneous coronary intervention (PCI) in ESRD patients who have proven coronary artery occlusive disease. This study was based on the National Health Insurance Service-National Sample Cohort in South Korea. We included 150 ESRD patients on chronic hemodialysis who underwent PCI with stenting between 2002 and 2013. The primary outcome was a composite of myocardial infarction, stroke, and all-cause mortality. Multivariate time-dependent Cox regression analysis were performed, and statin therapy after PCI was treated as a time-dependent variable. During 3.15 ± 2.71 (mean ± standard deviation) years of follow-up, there were 82 patients with primary outcome. The adjusted hazard ratio for statin use was 0.54 [0.33-0.90] compared to no statin use. This study showed that statin has significant benefit on reducing adverse events risk in dialysis-dependent ESRD patients after PCI.
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