Impact of chronic kidney disease on clinical and angiographic results following implantation of sirolimus-eluting coronary stents

Safety margin of minimized contrast volume during percutaneous coronary intervention in patients with chronic kidney disease

Maximum allowable contrast dose (MACD) calculated as body weight × 5/serum creatinine has been a standard contrast dye volume (CV) used to decrease contrast-induced acute kidney injury. Recent advances in intravascular ultrasound-guided percutaneous coronary intervention (PCI) can dramatically minimize CV. The safe threshold when using an extremely low-dose CV is unknown. This study was designed as a multicenter, retrospective study of chronic kidney disease (CKD) patients with estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m(2) undergoing elective PCI. We divided the patients into three groups according to following criteria: (1) low dose, CV/eGFR ratio <1.0; (2) medium dose, CV/eGFR ratio ≥1 and <MACD; and (3) high dose, CV ≥MACD. A total of 100 patients were enrolled. Average age was 74 ± 8 years, 64 % were male and 48 % were diabetic. Mean baseline eGFR was 22.8 ± 6.0 ml/min/1.73 m(2). CV in the three groups was 15 ± 6 ml (n = 18), 69 ± 39 ml (n = 47) and 224 ± 99 ml (n = 35), respectively. The incidences of CI-AKI were 0, 11 and 23 %, respectively (p = 0.02). All-cause death or introduction of maintenance hemodialysis at 1 year was 0, 13.8 and 31 %, respectively (p = 0.01). Extreme reduction of CV to a CV/eGFR ratio <1.0 may reduce CI-AKI and achieve better clinical outcomes following PCI in patients with severe CKD.

An assessment of risk factors for the complexity of coronary artery disease using the SYNTAX score

In 2005, the SYNTAX score was reported as "an angiographic tool grading the complexity of coronary artery disease". We investigated risk factors for the complexity of coronary artery disease (CAD) using SYNTAX scores in patients with new-onset CAD. The subjects were 359 consecutive cases that underwent de novo percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery without previous PCI history. Acute myocardial infarction was excluded. The SYNTAX scores were obtained from coronary angiographies performed before PCI. On multivariate linear regression analysis of risk factors for the SYNTAX scores, aging, being a male and having diabetes mellitus were identified as significant independent risk factors (age: multiple regression coefficient 0.27, p = 0.001; male: 4.91, p = 0.004; diabetes: 4.53, p = 0.001). Other coronary risk factors such as hypertension, hypercholesterolemia, smoking and reduced renal function were not identified as significant independent risk factors. In patients undergoing PCI, aging, being a male and having diabetes mellitus are considered to be independent risk factors for the complexity of CAD. Therefore, when patients with CAD have these factors, we expect the CAD of the patient to be more complex and that it will be necessary to provide more careful medical care.