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Zheng WC, Evans N, Dinh D, Bloom JE, Brennan AL, Ball J, Lefkovits J, Shaw JA, Reid CM, Chan W, Stub D. Clinical Outcomes of Renal Transplant Recipients Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2024:S1443-9506(24)00073-8. [PMID: 38565437 DOI: 10.1016/j.hlc.2024.01.033] [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: 11/28/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Clinical outcomes of patients with renal transplant (RT) undergoing percutaneous coronary intervention (PCI) remain poorly elucidated. METHOD Between 2014 and 2021, data were analysed for the following three groups of patients undergoing PCI enrolled in a multicentre Australian registry: (1) RT recipients (n=226), (2) patients on dialysis (n=992), and (3) chronic kidney disease (CKD) patients (estimated glomerular filtration rate [eGFR], 30‒60 mL/min per 1.73 m2) without previous RT (n=15,534). Primary outcome was 30-day major adverse cardiac and cerebrovascular events (MACCEs)-composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, and stroke. RESULTS RT recipients were younger than dialysis and patients with CKD (61±10 vs 68±12 vs 78±8.2 years, p<0.001). Patients with RT less frequently had severe left ventricular dysfunction compared with dialysis and CKD groups (6.7% vs 14% and 8.5%); however more, often presented with acute coronary syndrome (58% vs 52% and 48%), especially STEMI (all p<0.001). Patients with RT and CKD had lower rates of 30-day MACCE (4.4% and 6.8% vs 11.6%, p<0.001) than the dialysis group. Three-year survival was similar between RT and CKD groups, however was lower in the dialysis group (80% and 83% vs 60%, p<0.001). After adjustment, dialysis was an independent predictor of 30-day MACCE (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.44‒2.50, p<0.001), however RT was not (OR 0.91, CI 0.42‒1.96, p=0.802). Both RT (hazard ratio [HR] 2.07, CI 1.46‒2.95, p<0.001) and dialysis (HR 1.35, CI 1.02‒1.80, p=0.036) heightened the hazard of long-term mortality. CONCLUSIONS RT recipients have more favourable clinical outcomes following PCI compared with patients on dialysis. However, despite having similar short-term outcomes to patients with CKD, the hazard of long-term mortality is significantly greater for RT recipients.
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Affiliation(s)
- Wayne C Zheng
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Nicole Evans
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - James A Shaw
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Population Health, Curtin University, Perth, WA, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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Genetic risk model for in-stent restenosis of second-and third-generation drug-eluting stents. iScience 2021; 24:103082. [PMID: 34585120 PMCID: PMC8455661 DOI: 10.1016/j.isci.2021.103082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/20/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022] Open
Abstract
The new generation, i.e., second- and third-generation, drug-eluting stents (DESs) remain a risk of in-stent restenosis (ISR). We evaluated the power of a genetic risk score (GRS) model to identify high-risk populations for new generation DES ISR. We enrolled patients with coronary artery disease (CAD) treated with new generations DESs by a single-center cohort study in Taiwan and evaluated their genetic profile. After propensity score matching, there were 343 patients and 153 patients in the derivation and validation cohorts, respectively. Five selected single-nucleotide polymorphisms (SNPs), i.e., SNPs in CAMLG, GALNT2, C11orf84, THOC5, and SAMD11, were included to calculate the GRS for new generation DES ISR. In the derivation and the validation cohorts, patients with a GRS greater than or equal to 3 had significantly higher new generation DES ISR rates. We provide biological information for interventional cardiologists prior to percutaneous coronary intervention by specific five SNP-derived GRS. A validated GRS model identified high-risk population for new generation DES ISR This GRS includes 5 SNPs in exons: CAMLG, GALNT2, C11orf84, THOC5, and SAMD11 The patients with high GRSs (≥3) had higher rates of new generation DES ISR The GRS provides crucial information in shared decision-making process clinically
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Watanabe Y, Mitomo S, Demir OM, Liu KL, Tung YC, Chieffo A, Montorfano M, Chang CJ, Nakamura S, Colombo A. Clinical Outcomes of Dialysis Patients Treated with Drug-Eluting Stent for Left Main Distal Bifurcation Lesions. Cardiorenal Med 2021; 11:99-108. [PMID: 33657556 DOI: 10.1159/000510731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS We assessed clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) distal bifurcation lesions using drug-eluting stents (DES) in hemodialysis (HD) patients compared to non-HD patients. METHODS AND RESULTS We identified 1,858 consecutive patients who underwent PCI for ULMCA distal bifurcation lesions at 4 high-volume centers in Japan, Italy, and Taiwan between January 2005 and December 2015. Of them, 1,416 patients were treated with DES including 113 HD patients and 1,303 non-HD patients. The primary end point was target lesion failure (TLF) defined as a composite of cardiac death, target lesion revascularization (TLR), and myocardial infarction. HD patients were more likely to be younger and have diabetes mellitus, dyslipidemia, peripheral artery disease, lower ejection fraction, and higher EuroSCORE. TLF rate at 3 years was significantly higher in HD group than in non-HD group (adjusted hazard ratio [HR] 2.43 [1.75-3.38], p < 0.001). Cardiac mortality and TLR rate were also significantly higher in HD group than in non-HD group (adjusted HR 3.85 [2.34-6.34], p < 0.001, and HR 2.10 [1.41-3.14], p < 0.001, respectively). CONCLUSIONS HD was strongly associated with adverse cardiac events after PCI for ULMCA distal bifurcation lesions with DES.
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Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy, .,Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan,
| | - Satoru Mitomo
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Ozan M Demir
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Kuan-Liang Liu
- Department of Cardiology, Landseed International Hospital, Taoyuan, Taiwan
| | - Ying-Chang Tung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Chi-Jen Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy
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Prasitlumkum N, Cheungpasitporn W, Sato R, Thangjui S, Thongprayoon C, Kewcharoen J, Bathini T, Vallabhajosyula S, Ratanapo S, Chokesuwattanaskul R. Comparison of coronary artery bypass graft versus drug-eluting stents in dialysis patients: an updated systemic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2021; 22:285-296. [PMID: 33633044 DOI: 10.2459/jcm.0000000000001167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION As percutaneous coronary intervention (PCI) technologies have been far improved, we hence conducted an updated systemic review and meta-analysis to determine the comparability between coronary artery bypass graft (CABG) and PCI with drug-eluting stent (DES) in ESRD patients. METHODS We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED and the Cochrane from inception to January 2020. Included studies were published observational studies that compared the risk of cardiovascular outcomes among dialysis patients with CABG and DES. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Subgroup analyses and meta-regression were performed to explore heterogeneity. RESULTS Thirteen studies were included in this analysis, involving total 56 422 (CABG 21 740 and PCI 34 682). Compared with DES, our study demonstrated CABG had higher 30-day mortality [odds ratio (OR) 3.85, P = 0.009] but lower cardiac mortality (OR 0.78, P < 0.001), myocardial infarction (OR 0.5, P < 0.001) and repeat revascularization (OR 0.35, P < 0.001). No statistical differences were found between CABG and DES for long-term mortality (OR 0.92, P = 0.055), composite outcomes (OR 0.88, P = 0.112) and stroke (OR 1.49, P = 0.457). Meta-regression suggested diabetes and the presence of left main coronary artery disease as an effect modifier of long-term mortality. CONCLUSION PCI with DES shared similar long-term mortality, composite outcomes and stroke outcomes to CABG among dialysis patients but still was associated with an improved 30-day survival. However, CABG had better rates of myocardial infarction, repeat revascularization and cardiac mortality.
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Affiliation(s)
- Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California
| | - Wisit Cheungpasitporn
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ryota Sato
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Ohio, USA
| | - Sittinun Thangjui
- Department of Internal Medicine, Basset Healthcare Network, Cooperstown, New York
| | | | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, Arizona
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Outcomes of Renal Transplant Recipients after Percutaneous Coronary Intervention. Am J Cardiol 2020; 125:1305-1311. [PMID: 32139159 DOI: 10.1016/j.amjcard.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/21/2022]
Abstract
Renal transplantation (RT) can improve life expectancy in hemodialysis (HD) patients. However, little is known about the outcomes of renal transplant recipients after percutaneous coronary intervention (PCI). This study aimed to elucidate the effect of RT on clinical outcomes after PCI. Renal transplant recipients who underwent PCI from 2002 to 2017 were enrolled. To evaluate the effectiveness of RT, we retrospectively reviewed HD patients who underwent PCI. Propensity-score matching was performed using logistic regression to control for differences in baseline characteristics. The primary outcome was the incidence of major adverse cardiac events. After propensity matching, patients were classified into the RT (n = 50) group and HD (n = 50) group. Kaplan-Meier analysis revealed that the incidence of major adverse cardiac events was significantly lower in the RT group than in the HD group (p < 0.0001). Moreover, RT was associated with a lower risk for all-cause death (odds ratio 0.04; 95% confidence interval 0.002 to 0.03; p = 0.0054) and target vessel revascularization (OR 0.27; 95% CI 0.07 to 0.79; p = 0.015). RT may improve clinical outcomes after PCI, and it is encouraged for HD patients to increase life expectancy and reduce the occurrence of adverse events after PCI. Further research would be warranted to support this finding.
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Soontorndhada K, Tanaka K, Yamaguchi J, Konami Y, Otsuki H, Nakao M, Jujo K, Arashi H, Hagiwara N. Long-term clinical outcomes after percutaneous coronary intervention to treat long lesions in hemodialysis patients in the era of second-generation drug-eluting stents. J Cardiol 2019; 75:374-380. [PMID: 31615745 DOI: 10.1016/j.jjcc.2019.09.004] [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: 05/14/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is little knowledge about clinical outcomes after the percutaneous coronary intervention (PCI) in hemodialysis patients with long lesions. The objective of the present study was to examine the long-term prognosis after PCI in hemodialysis patients in the second-generation drug-eluting stents (DES) era. METHODS We retrospectively enrolled 270 consecutive hemodialysis patients who underwent PCI using second-generation DES from January 2010 to July 2015. We defined long lesions as the total stent length >30mm. In total, 96 hemodialysis patients (35.6%) underwent PCI for long lesions. The median follow-up period was 2.7 years. The endpoints of this study were cardiac death, target lesion revascularization (TLR), and major adverse cardiovascular events (MACE), including cardiac death, non-fatal myocardial infarction, non-fatal stroke, stent thrombosis, and TLR. RESULTS The patients' baseline characteristics were similar between the long lesion and the non-long lesion groups, except for prior PCIs (long-lesion vs. non-long lesion=30.2% vs. 46.0%; p= 0.01). Kaplan-Meier analyses revealed that the incidence of cardiac death, TLR, and MACE were comparable between the two groups (long lesion vs. non-long lesion; 5.2% vs. 5.7%, log-rank p=0.84, 26.0% vs. 23.0%, log-rank p=0.29, and 43.8% vs. 40.2%; log-rank p=0.49, respectively). CONCLUSIONS Clinical outcomes of PCI for long lesions in hemodialysis patients were similar to that of non-long lesions. Long-stenting in hemodialysis patients, who were considered high-risk subset of adverse cardiovascular events, might be acceptable in the second-generation DES era.
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Affiliation(s)
- Kanintorn Soontorndhada
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuki Tanaka
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yutaka Konami
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisao Otsuki
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Masashi Nakao
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Kentaro Jujo
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Arashi
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
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Sattar S, Ahmed N, Akhter Z, Aijaz S, Lakhani S, Malik R, Pathan A. In-Hospital outcomes in acute coronary syndrome patients with concomitant severe chronic kidney disease undergoing percutaneous coronary intervention. Pak J Med Sci 2019; 35:291-297. [PMID: 31086503 PMCID: PMC6500806 DOI: 10.12669/pjms.35.2.276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To determine in-hospital mortality and major adverse cardiac events (MACE) in acute coronary syndrome (AMI) patients with underlying severe chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). Methods We conducted a retrospective cohort study from June'2013-December'2017 at Tabba Heart Institute, Karachi. Data was drawn from institutes' database modeled after US National Cardiovascular data CathPCI registry. All AMI (STEMI: ST-elevation myocardial infarction and NSTEMI: non-ST-elevation myocardial infarction) patients undergoing PCI with creatinine clearance <30ml/min or ESRD on hemodialysis were included in the study. Results During 54 months study period, 160 severe CKD patients underwent PCI. Mean age was 62.9±12.2 years. Men were 61.9%, hypertensive (81.3%) and diabetic (63.8%). Excluding dialysis patients, Creatinine clearance was 21.1±6.6ml/min/1.73m2. STEMI were 46.9% and 61.9% were Killip I. Mean SYNTAX score was 16.6±7.3. MACE occurred in 32.5% patients, of which 6(11.5%) had new hemodialysis and mortality: 17.5% were deceased. MACE predictor were cardiogenic shock (OR: 2.81, 95%CI: 1.17-6.74) and prior heart failure (OR: 6.84, 95%CI: 1.39-33.74), Predictor of mortality was cardiogenic shock or cardiac arrest (OR: 7.90, 95%CI: 2.95-21.17). Conclusion Severe CKD patients undergoing PCI for AMI have drastically poor outcomes therefore individualization and patient-centric care management is mandatory.
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Affiliation(s)
- Saadia Sattar
- Saadia Sattar, M.Sc Epi-Bio. Research Consultant, Department of Clinical Research, Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Naseer Ahmed
- Naseer Ahmed, MBBS Cardiology Fellow, Department of Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Zohaib Akhter
- Zohaib Akhter, M.Sc Epi-Bio. Research Consultant, Department of Clinical Research, Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Saba Aijaz
- Saba Aijaz, FCPS. Consultant Cardiologist, Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Shakir Lakhani
- Shakir Lakhani, FCPS. Consultant Cardiologist, Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Rehan Malik
- Rehan Malik, Research Officer, Department of Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Asad Pathan
- Asad Pathan, FACC. Consultant Cardiologist, Cardiology, Tabba Heart Institute, Karachi, Pakistan
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Otaki Y, Ashikaga T, Sasaoka T, Kurihara K, Yoshikawa S, Isobe M. Long-term clinical outcomes of permanent-polymer everolimus-eluting stent implantation following rotational atherectomy for severely calcified de novo coronary lesions: Results of a 22-center study (Tokyo-MD PCI Study). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:120-125. [DOI: 10.1016/j.carrev.2018.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 11/29/2022]
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Yang X, Liu Q, Yuan L, Wang H, Xie Q. Comparison of Limus-Eluting and Paclitaxel-Eluting Stents for Coronary Intervention in Patients with Chronic Kidney Disease. Int Heart J 2018; 59:1202-1210. [PMID: 30369569 DOI: 10.1536/ihj.17-583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronic kidney disease (CKD) patients have worse adverse cardiovascular outcomes after percutaneous coronary intervention (PCI). Clinical outcomes comparing a limus-eluting stent (LES) to a paclitaxel-eluting stent (PES) in patients with CKD remain controversial.A systematic search was conducted using PubMed, EMBASE, and Cochrane Library. A pooled odds ratio (OR) and 95% confidence interval (CI) were used to calculate original data. We conducted heterogeneity, quality assessment, and publication bias analyses.A total of 17 trials involving 10,724 patients were included. No significant differences were found regarding target vessel revascularization, target lesion revascularization (TLR), stent thrombosis (ST), myocardial infarction (MI), all-cause mortality, and major adverse cardiac events (MACE) between first-generation LES implantation and PES implantation. Second-generation LES implantation was associated with lower rates of all-cause mortality (OR, 0.56; 95% CI, 0.39-0.82; P = 0.003), MACE (OR, 0.61; 95% CI, 0.38-0.97; P = 0.04), and ST (OR, 0.45; 95% CI, 0.26-0.77; P = 0.004) compared with PES implantation. In all, the long-term all-cause mortality rate was significantly lower after LES implantation than after PES implantation in patients with CKD (OR, 0.78; 95% CI, 0.66-0.93; P = 0.004). However, second-generation LES implantation resulted in a higher rate of TLR (OR, 2.23; 95% CI, 1.53-3.25; P < 0.001) than PES implantation in dialysis patients.In patients with CKD, first-generation LES and PES implantation had comparable mortality and morbidity. Second-generation LES implantation was superior to PES in reducing long-term mortality, MACE, and ST. However, PES may be more effective than LES in dialysis patients.
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Affiliation(s)
- Xiuhui Yang
- Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
| | - Qingquan Liu
- Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
| | - Lijun Yuan
- Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
| | - Haoran Wang
- Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
| | - Qiaotao Xie
- Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
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Long-Term Outcomes of Drug-Eluting Stents Versus Bare-Metal Stents in End-Stage Renal Disease Patients on Dialysis. Cardiol Rev 2018; 26:277-286. [DOI: 10.1097/crd.0000000000000192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang Y, Zhu S, Gao P, Zhang Q. Comparison of coronary artery bypass grafting and drug-eluting stents in patients with chronic kidney disease and multivessel disease: A meta-analysis. Eur J Intern Med 2017; 43:28-35. [PMID: 28400078 DOI: 10.1016/j.ejim.2017.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The optimal revascularization strategy of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention with drug-eluting stent (PCI-DES) in patients with chronic kidney disease (CKD) and multivessel disease (MVD) remains unclear. METHODS Pubmed, EMBASE and Cochrane Library electronic databases were searched from inception until June 2016. Studies that evaluate the comparative benefits of DES versus CABG in CKD patients with multi-vessel disease were considered for inclusion. We pooled the odds ratios from individual studies and conducted heterogeneity, quality assessment and publication bias analyses. RESULTS A total of 11 studies with 29,246 patients were included (17,928 DES patients; 11,318 CABG). Compared with CABG, pooled analysis of studies showed DES had higher long-term all-cause mortality (OR, 1.22; p<0.00001), cardiac mortality (OR, 1.29; p<0.00001), myocardial infarction (OR, 1.89; p=0.02), repeat revascularization (OR, 3.47; p<0.00001) and major adverse cardiac and cerebrovascular events (MACCE) (OR, 2.00; p=0.002), but lower short-term all-cause mortality (OR, 0.33; p<0.00001) and cerebrovascular accident (OR, 0.64; p=0.0001). Subgroup analysis restricted to patients with end-stage renal disease (ESRD) yielded similar results, but no significant differences were found regarding CVA and MACCE. CONCLUSIONS CABG for patients with CKD and MVD had advantages over PCI-DES in long-term all-cause mortality, MI, repeat revascularization and MACCE, but the substantial disadvantage in short-term mortality and CVA. Future large randomized controlled trials are certainly needed to confirm these findings.
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Affiliation(s)
- Yushu Wang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, Sichuan, China
| | - Sui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Peijuan Gao
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, Sichuan, China.
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Shroff GR, Herzog CA. Coronary Revascularization in Patients with CKD Stage 5D: Pragmatic Considerations. J Am Soc Nephrol 2016; 27:3521-3529. [PMID: 27493258 DOI: 10.1681/asn.2016030345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Coronary revascularization decisions for patients with CKD stage 5D present a dilemma for clinicians because of high baseline risks of mortality and future cardiovascular events. This population differs from the general population regarding characteristics of coronary plaque composition and behavior, accuracy of noninvasive testing, and response to surgical and percutaneous revascularization, such that findings from the general population cannot be automatically extrapolated. However, this high-risk population has been excluded from all randomized trials evaluating outcomes of revascularization. Observational studies have attempted to address long-term outcomes after surgical versus percutaneous revascularization strategies, but inherent selection bias may limit accuracy. Compared with percutaneous strategies, surgical revascularization seems to have long-term survival benefit on the basis of observational data but associates with substantially higher short-term mortality rates. Percutaneous revascularization with drug-eluting and bare metal stents associates with a high risk of in-stent restenosis and need for future revascularization, perhaps contributing to the higher long-term mortality hazard. Off-pump coronary bypass surgery and the newest generation of drug-eluting stent platforms offer no definitive benefits. In this review, we address the nuances, complexities, and tradeoffs that clinicians face in determining the optimal method of coronary revascularization for this high-risk population.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and .,Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
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Summaria F, Giannico MB, Talarico GP, Patrizi R. Percutaneous coronary interventions and antiplatelet therapy in renal transplant recipients. Ther Adv Cardiovasc Dis 2016; 10:86-97. [PMID: 26680559 PMCID: PMC5933627 DOI: 10.1177/1753944715622120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular disease is the leading cause of mortality and morbidity following renal transplantation (RT), accounting for 40-50% of all deaths. After renal transplantation, an adverse cardiovascular event occurs in nearly 40% of patients; given the dialysis vintage and the average wait time, the likelihood of receiving coronary revascularization is very high. There is a significant gap in the literature in terms of the outcomes of prophylactic coronary revascularization in renal transplantation candidates. Current guidelines on myocardial revascularization stipulate that renal transplant patients with significant coronary artery disease (CAD) should not be excluded from the potential benefit of revascularization. Compared with percutaneous coronary intervention (PCI), however, coronary artery bypass grafting is associated with higher early and 30-day mortality. About one-third of renal transplant patients with CAD have to be treated invasively and so PCI is currently the most popular mode of revascularization in these fragile and compromised patients. A newer generation drug-eluting stent (DES) should be preferred over a bare metal stent (BMS) because of its lower risk of restenosis and improved safety concerns (stent thrombosis) compared with first generation DES and BMS. Among DES, despite no significant differences being reported in terms of efficacy, the newer everolimus and zotarolimus eluting stents should be preferred given the possibility of discontinuing, if necessary, dual antiplatelet therapy before 12 months. Since there is a lack of randomized controlled trials, the current guidelines are inadequate to provide a specifically tailored antiplatelet therapeutic approach for renal transplant patients. At present, clopidogrel is the most used agent, confirming its central role in the therapeutic management of renal transplant patients undergoing PCI. While progress in malignancy-related mortality seems a more distant target, a slow but steady reduction in cardiovascular deaths, improving pharmacological and interventional therapy, is nowadays an achievable medium-term target in renal transplant patients.
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Affiliation(s)
- Francesco Summaria
- Cath-Lab/Department of Cardiology-Policlinico Casilino, Via Casilina, 1049, Rome 00199, Italy
| | | | | | - Roberto Patrizi
- Cath-Lab/Department of Cardiology-Policlinico Casilino, Rome, Italy
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Agrawal H, Aggarwal K, Littrell R, Velagapudi P, Turagam MK, Mittal M, Alpert MA. Pharmacological and non pharmacological strategies in the management of coronary artery disease and chronic kidney disease. Curr Cardiol Rev 2015; 11:261-9. [PMID: 25981315 PMCID: PMC4558358 DOI: 10.2174/1573403x1103150514155757] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 12/18/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
Patients with advanced chronic kidney disease (CKD), including those treated with dialysis, are at high risk for the development of cardiovascular disease (CVD). CVD accounts for 45-50% of deaths among dialysis patients. Therapy of acute and chronic coronary heart disease (CHD) that is effective in the general population is frequently less effective in patients with advanced CKD. Drug therapy in such patients may require dose modification in some cases. Oral anti-platelet drugs are less effective in those with advanced CKD than in persons with normal or near normal renal function. The intravenous antiplatelet drugs eptifibatide and tirofiban both require dose reductions in patients with advanced CKD. Enoxaparin requires dose reduction in early stage CKD and is contraindicated in hemodialysis patients. Unfractionated heparin and warfarin maybe used without dose adjustment in CKD patients. Atenolol, acetbutolol and nadolol may require dose adjustments in CKD. Metoprolol and carvedilol do not. Calcium channel blockers and nitrates do not require dose adjustment, whereas ranolazine does. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers may safely be used in CKD patients with close observation for hyperkalemia. The safety of spironolactone in such patients is questionable. Statins are less effective in reducing cardiovascular complication in CKD patients and their initiation is not recommended in dialysis patients. Coronary artery bypass grafting is associated with higher short-term mortality, but better long-term morbidity and mortality than percutaneous coronary interventions in patients with advanced CKD with non-ST segment ACS and chronic CHD.
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Affiliation(s)
| | | | | | | | - Mohit K Turagam
- Rm CE-306, University of Missouri Health Sciences Center, 5 Hospital Drive, Columbia, MO, USA 65212.
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Buronova N, Kamishima K, Yamaguchi J, Jujo K, Watanabe E, Inagaki Y, Kishi S, Wada A, Hatakeyama S, Watanabe M, Nakao M, Okayama D, Arashi H, Yamada N, Takagi A, Ogawa H, Hagiwara N. Effect of Hemodialysis on 7-Year Clinical Outcomes After Sirolimus-Eluting Stent Implantation. Circ J 2015; 79:2169-76. [PMID: 26310781 DOI: 10.1253/circj.cj-15-0113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hemodialysis (HD) patients are reported to show poor clinical outcomes after percutaneous coronary intervention (PCI) with sirolimus-eluting stent (SES) compared with non-HD patients and their long-term prognosis remains unclear. METHODS AND RESULTS We prospectively enrolled 489 consecutive patients undergoing PCI with SES and performed a retrospective analysis focusing on HD patients. Median follow-up was 7.0 years (interquartile range, 4.2-7.9) and the follow-up rate was 100%. At the 7-year follow-up, the cumulative incidences of all-cause death, target lesion revascularization (TLR) and major adverse cardiac events (MACE) were significantly higher in HD patients than in non-HD patients (HD vs. non-HD=34.7% vs. 9.6%, 42.6% vs. 10.2% and 75.3% vs. 24.4%, respectively; log-rank P<0.001). Cox-proportional hazard analysis revealed that independent predictors of all-cause death were HD (hazard ratio [HR] 2.88, 95% confidence interval [CI]: 1.39-6.00), insulin-treated diabetes mellitus (HR 2.19, 95% CI: 1.17-4.11), heart failure (HR 2.58, 95% CI: 1.25-5.32) and older age (HR 1.06/1-age, 95% CI: 1.02-1.10). Moreover, HD was an independent predictor of TLR (HR 3.63, 95% CI: 1.85-7.11) and MACE (HR 3.54, 95% CI: 2.19-5.73). CONCLUSIONS In the present study, Japanese HD patients undergoing PCI with SES showed poorer long-term clinical outcomes than non-HD patients. HD was a strong predictor of long-term adverse events after SES implantation.
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Affiliation(s)
- Nozima Buronova
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University
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McCullough PA, Verrill TA. Cardiorenal Interaction: Appropriate Treatment of Cardiovascular Risk Factors to Improve Outcomes in Chronic Kidney Disease. Postgrad Med 2015; 122:25-34. [DOI: 10.3810/pgm.2010.03.2119] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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17
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Ogita M, Miyauchi K, Kasai T, Doi S, Wada H, Naito R, Konishi H, Tsuboi S, Dohi T, Tamura H, Okazaki S, Daida H. Impact of preprocedural high-sensitive C-reactive protein levels on long-term clinical outcomes of patients with stable coronary artery disease and chronic kidney disease who were treated with drug-eluting stents. J Cardiol 2015; 66:15-21. [PMID: 25572020 DOI: 10.1016/j.jjcc.2014.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/03/2014] [Accepted: 10/14/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND To evaluate the prognostic impact of preprocedural high-sensitivity C-reactive protein (hsCRP) levels on the long-term clinical outcomes after first-generation drug-eluting stent (DES) implantation in chronic kidney disease (CKD) patients with stable coronary artery disease (CAD). METHODS AND RESULTS We found significant interaction between CKD and hsCRP levels (p=0.0138) in 1176 consecutive patients with stable CAD who were treated with first-generation DES implantation between 2004 and 2009 at our institution. Therefore, we separately analyzed data from patients with and without CKD who were assigned to tertiles based on preprocedural hsCRP levels. We evaluated the incidence of major adverse cardiovascular events (MACE) comprising all-cause death, nonfatal myocardial infarction, and target vessel revascularization after percutaneous coronary intervention during a median follow-up period of 1266 days. The rate of MACE significantly differed among the tertiles (log-rank p=0.0074) in the group with CKD. Multivariate Cox regression analysis significantly associated a higher hsCRP tertile with MACE in the CKD group (hazard ratio 2.39, 95% confidence interval 1.27-4.75, p=0.0062). CONCLUSION Elevated preprocedural serum hsCRP levels might be associated with the long-term clinical outcomes of patients with stable CAD and CKD who were implanted with first-generation DES.
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Affiliation(s)
- Manabu Ogita
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Katsumi Miyauchi
- Juntendo University, Department of Cardiovascular Medicine, Japan.
| | - Takatoshi Kasai
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Shinichiro Doi
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Hideki Wada
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Ryo Naito
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Hirokazu Konishi
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Shuta Tsuboi
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Tomotaka Dohi
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Hiroshi Tamura
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Shinya Okazaki
- Juntendo University, Department of Cardiovascular Medicine, Japan
| | - Hiroyuki Daida
- Juntendo University, Department of Cardiovascular Medicine, Japan
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Tsai ML, Hsieh IC, Hung CC, Chen CC. Serum Free Indoxyl Sulfate Associated with In-stent Restenosis After Coronary Artery Stentings. Cardiovasc Toxicol 2014; 15:52-60. [DOI: 10.1007/s12012-014-9270-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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19
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Chan W, Ivanov J, Kotowycz MA, Sibbald M, McGeoch R, Crooks N, Hatton R, Ing D, Daly P, Mackie K, Osten MD, Seidelin PH, Barolet A, Overgaard CB, Džavík V. Association Between Drug-Eluting Stent Type and Clinical Outcomes in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention. Can J Cardiol 2014; 30:1170-6. [DOI: 10.1016/j.cjca.2014.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/07/2014] [Accepted: 04/17/2014] [Indexed: 12/14/2022] Open
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20
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Otsuka M, Yokoi H, Matsuyama Y, Hayashi Y, Shiode N, Masaoka Y, Okimoto T, Tamekiyo H, Kawase T, Yamane K, Kagawa Y, Nakamura M, Muramatsu T, Nanto S. Comparison of sirolimus- and paclitaxel-eluting stents in patients with moderate renal insufficiency: results from the J-DESsERT trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:323-8. [PMID: 25284808 DOI: 10.1016/j.carrev.2014.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/03/2014] [Accepted: 09/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is unclear whether there are differences in clinical outcomes between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with moderate renal insufficiency (RI). METHODS The Japan-Drug Eluting Stents Evaluation; a Randomized Trial (J-DESsERT) was a prospective, randomized multicenter trial which compared 1:1 coronary stenting between SES and PES patients. Patient with serious RI (serum creatinine value 2mg/dL or higher) were excluded. Patients were classified into 2 arms according to renal function: a non-RI arm of 2220 patients (SES 1094 and PES 1126 patients with estimated glomerular filtration rate (eGFR) ≥60 mL min(-1) 1.73 m(-2)) and an RI arm of 1206 patients (SES 613, PES 593 with 30≤eGFR <60 mL min(-1) 1.73 m(-2)). RESULTS At 12 months, the primary endpoint of target vessel failure in the non-RI arm occurred in 6.0% in the SES group and 8.7% in the PES group (p=0.02). In the RI arm, this occurred in 5.7% and 8.1% (p=0.10). Mortality rates were 0.8% vs 0.7% (p=0.78) in the non-RI arm, and 2.2% vs 2.1% (p=0.90) in the RI arm. Cardiac death was 0.4% vs 0.1% (p=0.17) in the non-RI arm, and 1.0% vs 1.0% (p=0.96) in the RI arm. Mortality was higher in patients with RI than those without RI (2.1% vs 0.8%; p<0.01). Cardiac death rates increased in the RI arm compared with those in the non-RI arm (1.0% vs 0.2%; p<0.01). CONCLUSIONS Regardless of the presence or absence of moderate RI, differences in outcomes between SES and PES change little except mortality and cardiac death.
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Affiliation(s)
- Masaya Otsuka
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
| | - Hiroyoshi Yokoi
- Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Hayashi
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Nobuo Shiode
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Yoshiko Masaoka
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Tomokazu Okimoto
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Hiromichi Tamekiyo
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Tomoharu Kawase
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Kenichi Yamane
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Yuzo Kagawa
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Masato Nakamura
- Department of Cardiovascular Medicine, Toho University School of Medicine, Ohashi Medical Center, Tokyo, Japan
| | - Toshiya Muramatsu
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Shinsuke Nanto
- Nishinomiya Hospital Affairs, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
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Hong YJ, Jeong MH, Choi YH, Park SY, Rhew SH, Kim SS, Jeong YW, Jeong HC, Cho JY, Jang SY, Lee KH, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC. Relation between renal function and neointimal tissue characteristics after drug-eluting stent implantation: Virtual histology-intravascular ultrasound analysis. J Cardiol 2014; 64:98-104. [DOI: 10.1016/j.jjcc.2013.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/20/2013] [Accepted: 11/27/2013] [Indexed: 11/16/2022]
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22
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Deo SV, Shah IK, Dunlay SM, Lim JY, Erwin PJ, Dillon JJ, Park SJ. Coronary Artery Bypass Grafting Versus Drug-Eluting Stents in Patients with End-Stage Renal Disease. J Card Surg 2014; 29:163-9. [DOI: 10.1111/jocs.12296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Salil V. Deo
- Department of Cardiovascular Surgery; Adventist Wockhardt Heart Institute; Surat, Gujarat India
| | - Ishan K. Shah
- Department of Surgery; University of Minnesota; Minneapolis Minnesota
| | - Shannon M. Dunlay
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Ju Yong Lim
- Division of Cardiovascular Surgery; Mayo Clinic; Rochester Minnesota
| | | | - John J. Dillon
- Division of Nephrology and Hypertension; Mayo Clinic; Rochester Minnesota
| | - Soon J. Park
- Division of Cardiovascular Surgery; University Hospitals; Case Western Reserve University; Cleveland Ohio
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Konishi A, Shinke T, Otake H, Nakatani D, Nakagawa M, Inoue T, Hariki H, Osue T, Taniguchi Y, Iwasaki M, Nishio R, Hiranuma N, Kinutani H, Kuroda M, Shite J, Hirata KI. Impact of hemodialysis on local vessel healing and thrombus formation after drug-eluting stent implantation. J Cardiol 2013; 64:25-31. [PMID: 24377659 DOI: 10.1016/j.jjcc.2013.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/04/2013] [Accepted: 10/29/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although hemodialysis (HD) is a suggested risk factor for stent thrombosis, its contribution to local vessel healing after drug-eluting stent (DES) implantation is unclear. METHODS A total of 121 patients (152 lesions treated with DES) who underwent 8-month follow-up coronary angiography with optical coherence tomography (OCT) were enrolled, and the findings were compared between patients with and without HD. To match baseline differences, mid-term OCT findings of 42 propensity score-matched lesions (21 non-HD vs. 21 HD) were compared. Effects of HD on the efficacy of antiplatelet therapy were also evaluated by VerifyNow assay (Accumetrics, San Diego, CA, USA). RESULTS Patients with HD had a significantly higher rate of thrombus formation than those without (64% vs. 33%, p = 0.007), although the baseline parameters and lesion characteristics differed between the groups. Multivariate logistic regression analysis revealed that HD was associated with an increased risk of thrombus formation (odds ratio 5.991, 95% confidence interval: 1.972-18.199, p = 0.002). Even after propensity-matching for patient background and balancing of angiographic and OCT variables, the risk of thrombus formation remained significantly higher in HD patients. The P2Y12-reaction unit was significantly increased after HD (Pre HD: 211 ± 75 vs. Post HD: 262 ± 59, p = 0.01), but patients without HD showed no increase during the same elapsed time (221 ± 88 vs. 212 ± 96, p = 0.19). CONCLUSIONS HD is a potential risk factor for subclinical thrombus attachment after DES therapy. Systemic problems, such as residual platelet reactivity, associated with HD as well as local vessel features in HD patients might contribute to the increased incidence of thrombus attachment and subsequent onset of thrombotic event after DES implantation.
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Affiliation(s)
- Akihide Konishi
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Toshiro Shinke
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
| | - Hiromasa Otake
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Nakagawa
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Takumi Inoue
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Hirotoshi Hariki
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Tsuyoshi Osue
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Yu Taniguchi
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Masamichi Iwasaki
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Ryo Nishio
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Noritoshi Hiranuma
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Hiroto Kinutani
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Masaru Kuroda
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Junya Shite
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Ken-ichi Hirata
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
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Favaretto E, Valente L, Napodano M, Frigo AC, Buja P, Ronco F, Cruz DN, Xhaxho J, Naso P, Ronco C, Isabella G, Iliceto S, Tarantini G. Chronic kidney disease and percutaneous coronary interventions with drug-eluting stents: Does the K/DOQI classification matter? Int J Cardiol 2013; 166:530-3. [DOI: 10.1016/j.ijcard.2012.09.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 09/22/2012] [Indexed: 11/30/2022]
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Shroff GR, Solid CA, Herzog CA. 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. Circulation 2013; 127:1861-9. [PMID: 23572500 DOI: 10.1161/circulationaha.112.001264] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few published data describe long-term survival of dialysis patients undergoing surgical versus percutaneous coronary revascularization in the era of drug-eluting stents (DES). METHODS AND RESULTS Using United States Renal Data System data, we identified 23 033 dialysis patients who underwent coronary revascularization (6178 coronary artery bypass grafting, 5011 bare metal stents, 11 844 DES) from 2004 to 2009. Revascularization procedures decreased from 4347 in 2004 to 3344 in 2009. DES use decreased by 41% and bare metal stent use increased by 85% from 2006 to 2007. Long-term survival was estimated by the Kaplan-Meier method, and independent predictors of mortality were examined in a comorbidity-adjusted Cox model. In-hospital mortality for coronary artery bypass grafting patients was 8.2%; all-cause survival at 1, 2, and 5 years was 70%, 57%, and 28%, respectively. In-hospital mortality for DES patients was 2.7%; 1-, 2-, and 5-year survival was 71%, 53%, and 24%, respectively. Independent predictors of mortality were similar in both cohorts: age >65 years, white race, dialysis duration, peritoneal dialysis, and congestive heart failure, but not diabetes mellitus. Survival was significantly higher for coronary artery bypass grafting patients who received internal mammary grafts (hazard ratio, 0.83; P<0.0001). The probability of repeat revascularization accounting for the competing risk of death was 18% with bare metal stents, 19% with DES, and 6% with coronary artery bypass grafting at 1 year. CONCLUSIONS Among dialysis patients undergoing coronary revascularization, in-hospital mortality was higher after coronary artery bypass grafting, but long-term survival was superior with internal mammary grafts. In-hospital mortality was lower for DES patients, but the probability of repeat revascularization was higher and comparable to that in patients receiving a bare metal stent. Revascularization decisions for dialysis patients should be individualized.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
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Muller C, Caillard S, Jesel L, El Ghannudi S, Ohlmann P, Sauleau E, Hannedouche T, Gachet C, Moulin B, Morel O. Association of Estimated GFR With Platelet Inhibition in Patients Treated With Clopidogrel. Am J Kidney Dis 2012; 59:777-85. [DOI: 10.1053/j.ajkd.2011.12.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 12/22/2011] [Indexed: 11/11/2022]
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Rothman MT, Jain AK. Outcomes in patients with renal impairment undergoing percutaneous coronary intervention and implantation of the Endeavor zotarolimus-eluting stent: 1- and 2-year data from the E-Five Registry. Catheter Cardiovasc Interv 2012; 80:885-92. [PMID: 22517785 DOI: 10.1002/ccd.23484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 10/31/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Renal impairment (RI) is a predictor of poor outcomes in patients with cardiovascular disease, but its influence in the setting of percutaneous coronary intervention and zotarolimus-eluting stent (ZES) implantation has not been described. This study evaluated the impact of RI on clinical outcomes in patients participating in the E-Five Registry. BACKGROUND E-Five was a prospective, multicenter, global registry of 8,314 patients; 2,116 patients were followed to 2 years. METHODS Patients (excluding those who had undergone renal transplantation) were grouped according to renal function (normal function/mild RI, serum creatinine <110 μmol/L; moderate RI, 110-200 μmol/L; severe RI, >200 μmol/L) and their outcomes evaluated retrospectively. Major adverse cardiac events (MACE; i.e., death, myocardial infarction, emergency cardiac bypass surgery, or target lesion revascularization) and stent thrombosis events at 1 and 2 years were compared between groups. RESULTS The 1-year MACE rate in patients with mild RI was 6.8%, compared with 8.9 and 18.1% in patients with moderate and severe RI (P = 0.002 across groups). At 2 years, death occurred in 16% of those with severe RI, compared with 2.0 and 4.7% in those with mild and moderate RI (P = 0.002). There was no significant difference in the rates of target lesion revascularization or target vessel failure. CONCLUSIONS Greater severity of RI at intervention is associated with greater mortality and MACE but unchanged revascularization rates after ZES implantation.
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Affiliation(s)
- Martin T Rothman
- Department of Cardiology, The London Chest Hospital, Barts, United Kingdom.
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Best PJM. Percutaneous coronary revascularization for myocardial infarction in chronic kidney disease: recognizing the risk while seizing the benefits. JACC Cardiovasc Interv 2011; 4:1009-10. [PMID: 21939941 DOI: 10.1016/j.jcin.2011.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022]
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Kaya E, Cuneo A, Hochadel M, Jünger C, Stepper W, Bramlage P, Kuck KH, Nienaber CA, Senges J, Eckardt L, Tebbe U, Reinecke H. Impact of chronic kidney disease on the prognosis of patients undergoing percutaneous coronary interventions using drug-eluting stents. Clin Res Cardiol 2011; 100:1103-9. [PMID: 21912915 DOI: 10.1007/s00392-011-0347-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 07/13/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) has an adverse impact on survival of patients with coronary artery disease and is associated with poor outcomes after percutaneous coronary intervention (PCI). Although small randomized, controlled clinical trials showed a reduced target vessel revascularization rate and a good safety profile for sirolimus-eluting coronary stents (SES), safety data need to be confirmed in clinical practice. Therefore, the data of the German DES.DE registry were evaluated to obtain acute and long-term data of this high-risk subgroup. METHODS The prospective multicenter German DES.DE registry enables to monitor the therapeutic outcome of different drug-eluting stents in the context of the German Health Care System. Baseline clinical and angiographic characteristics as well as one-year-follow-up data were recorded. From October 2005 to October 2006, 6,384 patients were enrolled at 98 DES.DE sites and stratified according to kidney disease progression: normal and impaired renal function and patients under chronic hemodialysis. RESULTS CKD was associated with several acute and chronic medical conditions and suffer from significantly more cardiac and cerebrovascular events after PCI as compared to patients without CKD. One-year-follow-up showed a significantly increased risk of restenosis and bleeding complications in patients with impaired renal function, especially in hemodialysis patients. CONCLUSIONS Impaired renal function in patients undergoing DES stenting carries an independent risk factor for restenosis and bleeding.
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Affiliation(s)
- Elif Kaya
- Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer Strasse 33, 48149, Münster, Germany.
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Brunet P, Gondouin B, Duval-Sabatier A, Dou L, Cerini C, Dignat-George F, Jourde-Chiche N, Argiles A, Burtey S. Does uremia cause vascular dysfunction? Kidney Blood Press Res 2011; 34:284-90. [PMID: 21691132 DOI: 10.1159/000327131] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Vascular dysfunction induced by uremia has 4 main aspects. (1) Atherosclerosis is increased. Intima-media thickness is increased, and animal studies have established that uremia accelerates atherosclerosis. Uremic toxins are involved in several steps of atherosclerosis. Leukocyte activation is stimulated by guanidines, advanced glycation end products (AGE), p-cresyl sulfate, platelet diadenosine polyphosphates, and indoxyl sulfate. Endothelial adhesion molecules are stimulated by indoxyl sulfate. Migration and proliferation of vascular smooth muscle cells (VSMC) are stimulated by local inflammation which could be triggered by indoxyl sulfate and AGE. Uremia is associated with an increase in von Willebrand factor, thrombomodulin, plasminogen activator inhibitor 1, and matrix metalloproteinases. These factors contribute to thrombosis and plaque destabilization. There is also a decrease in nitric oxide (NO) availability, due to asymmetric dimethylarginine (ADMA), AGE, and oxidative stress. Moreover, circulating endothelial microparticles (EMP) are increased in uremia, and inhibit the NO pathway. EMP are induced in vitro by indoxyl sulfate and p-cresyl sulfate. (2) Arterial stiffness occurs due to the loss of compliance of the vascular wall which induces an increase in pulse pressure leading to left ventricular hypertrophy and a decrease in coronary perfusion. Implicated uremic toxins are ADMA, AGE, and oxidative stress. (3) Vascular calcifications are increased in uremia. Their formation involves a transdifferentiation process of VSMC into osteoblast-like cells. Implicated uremic toxins are mainly inorganic phosphate, as well as reactive oxygen species, tumor necrosis factor and leptin. (4) Abnormalities of vascular repair and neointimal hyperplasia are due to VSMC proliferation and lead to severe reduction of vascular lumen. Restenosis after coronary angioplasty is higher in dialysis than in nondialysis patients. Arteriovenous fistula stenosis is the most common cause of thrombosis. Uremic toxins such as indoxyl sulfate and some guanidine compounds inhibit endothelial proliferation and wound repair. Endothelial progenitor cells which contribute to vessel repair are decreased and impaired in uremia, related to high serum levels of β(2)-microglobulin and indole-3 acetic acid. Overall, there is a link between kidney function and cardiovascular risk, as emphasized by recent meta-analyses. Moreover, an association has been reported between cardiovascular mortality and uremic toxins such as indoxyl sulfate, p-cresol and p-cresyl sulfate.
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Choi DH, Park KW, Yang HM, Lee HY, Park JS, Kang HJ, Kim YJ, Koo BK, Oh BH, Park YB, Kim HS. Renal dysfunction and high levels of hsCRP are additively associated with hard endpoints after percutaneous coronary intervention with drug eluting stents. Int J Cardiol 2011; 149:174-181. [DOI: 10.1016/j.ijcard.2010.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 11/11/2009] [Accepted: 01/07/2010] [Indexed: 10/19/2022]
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Alexander P, David S, McCullough PA. Drug-Eluting Coronary Stents in Patients With Kidney Disease. Am J Kidney Dis 2011; 57:188-9. [DOI: 10.1053/j.ajkd.2010.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 12/06/2010] [Indexed: 11/11/2022]
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Relationship between renal function stage and clinical outcomes after paclitaxel-eluting stent implantation. J Cardiol 2011; 57:61-8. [DOI: 10.1016/j.jjcc.2010.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 09/30/2010] [Accepted: 10/25/2010] [Indexed: 11/17/2022]
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Cardiovascular Mortality in Chronic Kidney Disease Patients Undergoing Percutaneous Coronary Intervention Is Mainly Related to Impaired P2Y12 Inhibition by Clopidogrel. J Am Coll Cardiol 2011; 57:399-408. [DOI: 10.1016/j.jacc.2010.09.032] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 09/08/2010] [Accepted: 09/28/2010] [Indexed: 12/20/2022]
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Bae EH, Lim SY, Choi YH, Suh SH, Cho KH, Choi JS, Kim CS, Park JW, Ma SK, Jeong MH, Kim SW, Korea Acute Myocardial Infarction Registry investigators. Drug-Eluting vs. Bare-Metal Stents for Treatment of Acute Myocardial Infarction With Renal Insufficiency. Circ J 2011; 75:2798-804. [DOI: 10.1253/circj.cj-11-0586] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School
| | - Sang Yup Lim
- Department of Internal Medicine, Korea University
| | - Young Hwan Choi
- Department of Internal Medicine, Chonnam National University Medical School
| | - Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School
| | - Kyung Hoon Cho
- Department of Internal Medicine, Chonnam National University Medical School
| | - Joon Seok Choi
- Department of Internal Medicine, Chonnam National University Medical School
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School
| | - Jeong Woo Park
- Department of Internal Medicine, Chonnam National University Medical School
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Medical School
- Cardiovascular Research Institute of Chonnam National University
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School
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Charytan DM, Varma MR, Silbaugh TS, Lovett AF, Normand SLT, Mauri L. Long-term clinical outcomes following drug-eluting or bare-metal stent placement in patients with severely reduced GFR: Results of the Massachusetts Data Analysis Center (Mass-DAC) State Registry. Am J Kidney Dis 2010; 57:202-11. [PMID: 21186075 DOI: 10.1053/j.ajkd.2010.09.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 09/10/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with chronic kidney disease have been under-represented in randomized trials of drug-eluting stents relative to bare-metal stents and are at high risk of mortality. STUDY DESIGN Cohort study with propensity score matching. SETTINGS & PARTICIPANTS All adults with chronic kidney disease and severely decreased glomerular filtration rate (GFR; serum creatinine >2.0 mg/dL or dialysis dependence) undergoing percutaneous coronary intervention with stent placement between April 1, 2003, and September 30, 2005, at all acute-care nonfederal hospitals in Massachusetts. PREDICTOR Patients were classified as drug-eluting stent-treated if all stents were drug eluting and bare-metal stent-treated if all stents were bare metal. Patients treated with both types of stents were excluded from the primary analysis. OUTCOMES & MEASUREMENTS 2-year crude mortality risk differences (drug-eluting - bare-metal stents) were determined from vital statistics records, and risk-adjusted mortality, myocardial infraction (MI), and revascularization differences were estimated using propensity score matching of patients with severely reduced GFR based on clinical and procedural information collected at the index admission. RESULTS 1,749 patients with severely reduced GFR (24% dialysis dependent) were treated with drug-eluting (n = 1,256) or bare-metal stents (n = 493) during the study. Overall 2-year mortality was 32.8% (unadjusted drug-eluting stent vs bare-metal stent; 30.1% vs 39.8%; P < 0.001). After propensity score matching 431 patients with a drug-eluting stent to 431 patients with a bare-metal stent, 2-year risk-adjusted mortality, MI, and target-vessel revascularization rates were 39.4% versus 37.4% (risk difference, 2.1%; 95% CI, -4.3 to 8.5; P = 0.5), 16.0% versus 19.0% (risk difference, -3.0%; 95% CI, -8.2 to 2.1; P = 0.3), and 13.0% versus 17.6% (risk difference, -4.6%; 95% CI, -9.5 to 0.3; P = 0.06). LIMITATIONS Observational design, ascertainment of serum creatinine level >2.0 mg/dL and dialysis dependence from case report forms. CONCLUSIONS In patients with severely decreased GFR, treatment with drug-eluting stents was associated with a modest decrease in target-vessel revascularization not reaching statistical significance and was not associated with a difference in risk-adjusted rates of mortality or MI at 2 years compared with bare-metal stents.
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Impact of chronic kidney disease on clinical and angiographic results following implantation of sirolimus-eluting coronary stents. Cardiovasc Interv Ther 2010; 26:18-25. [DOI: 10.1007/s12928-010-0029-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
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Lee MS, Hu PP, Aragon J, Shah A, Bhatia R, Jones N, Penny W, French W, Tobis J, Mahmud E. Impact of chronic renal insufficiency on clinical outcomes in patients undergoing saphenous vein graft intervention with drug-eluting stents: A multicenter Southern Californian Registry. Catheter Cardiovasc Interv 2010; 76:272-8. [DOI: 10.1002/ccd.22479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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