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Rotablation in Patients with Advanced Renal Insufficiency through End-Stage Renal Disease: Short- and Intermediate-Term Results. J Interv Cardiol 2022; 2022:7884401. [PMID: 35350479 PMCID: PMC8930227 DOI: 10.1155/2022/7884401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. Patients with advanced renal insufficiency are at high risk of coronary artery disease (CAD) and complex lesions. Treating complex calcified lesion with rotational atherectomy (RA) in these patients might be associated with higher risks and poorer outcomes. This study was set to evaluate features and outcomes of RA in these patients. Method. Consecutive patients who received coronary RA from April 2010 to April 2018 were queried from the Cath Lab database. The procedural details, angiography, and clinical information were reviewed in detail. Results. A total of 411 patients were enrolled and divided into Group A (baseline serum creatinine <5 mg/dl, n = 338) and Group B (baseline serum creatinine ≥ 5 mg/dl through ESRD, n = 73). Most patients had high-risk features (65.7% of acute coronary syndrome (ACS), 14.1% of ischemic cardiomyopathy, and 5.1% of cardiogenic shock). Group B patients were significantly younger (66.8 ± 11.4 vs. 75.2 ± 10.7 years,
) and had more RCA and LCX but less LAD treated with RA. No difference was found in lesion location, vessel tortuosity, bifurcation lesions, chronic total occlusion, total lesion length, or total lesion numbers between the two groups. Less patients in Group B obtained completion of RA (95.9% vs 99.1%,
). There was no difference in the incidence of procedural complication or acute contrast-induced nephropathy. Group B patients had more deaths and MACE while in the hospital. The MACE and CV MACE were also higher in Group B patients at 180 days and one year, mostly due to TLR and TVR. Multivariate regression analysis showed that ACS, age, peripheral artery disease (PAD), advanced renal insufficiency, ischemic cardiomyopathy/shock, and high residual SYNTAX score were independent risk factors for in-hospital MACE, whereas ACS, advanced renal insufficiency, ischemic cardiomyopathy/shock, triple-vessel disease, and PAD independently predicted MACE at 6 months. Conclusions. Rotablation is feasible, safe, and could be carried out with very high success rate in very-high-risk patients with advanced renal dysfunction through ESRD without an increase in procedural complication.
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Truby LK, Mentz RJ, Agarwal R. Cardiovascular risk stratification in the noncardiac solid organ transplant candidate. Curr Opin Organ Transplant 2022; 27:22-28. [PMID: 34939961 PMCID: PMC9946722 DOI: 10.1097/mot.0000000000000942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Solid organ transplantation (SOT) has become a widely accepted therapy for end-stage disease across the spectrum of thoracic and abdominal organs. With contemporary advances in medical and surgical therapies in transplantation, candidates for SOT are increasingly older with a larger burden of comorbidities, including cardiovascular disease (CVD). CVD, in particular, is a leading cause of morbidity and mortality in SOT candidates with end-stage disease of noncardiac organs [1]. RECENT FINDINGS Identification of coronary artery disease (CAD), heart failure, and valvular disease are important in noncardiac SOT to ensure both appropriate peri-transplant management and equitable organ allocation. Although the American College of Cardiology (ACC) and the American Heart Association (AHA) have published guidelines and recommendations for the perioperative cardiovascular evaluation of patients undergoing noncardiac surgery, the implications of both symptomatic and asymptomatic CVD differ in patients with end-stage organ failure being considered for SOT when compared to the general population. SUMMARY Herein, we review the epidemiology, diagnosis, and evidence for the management of CVD in kidney and liver transplantation, combining current guidelines from the 2012 ACC/AHA scientific statement on cardiac disease evaluation in SOT with more contemporary evidenced-based algorithms.
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Affiliation(s)
- Lauren K. Truby
- Division of Cardiology, Department of Medicine, Durham, North Carolina, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robert J. Mentz
- Division of Cardiology, Department of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Richa Agarwal
- Division of Cardiology, Department of Medicine, Durham, North Carolina, USA
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3
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Costanzo P, Džavík V. Coronary Revascularization in Patients With Advanced Chronic Kidney Disease. Can J Cardiol 2019; 35:1002-1014. [DOI: 10.1016/j.cjca.2019.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/10/2019] [Accepted: 02/25/2019] [Indexed: 12/31/2022] Open
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4
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Knapper JT, Raval Z, Harinstein ME, Friedewald JJ, Skaro AI, Abecassis MI, Ali ZA, Gheorghiade M, Flaherty JD. Assessment and management of coronary artery disease in kidney and pancreas transplant candidates. J Cardiovasc Med (Hagerstown) 2019; 20:51-58. [DOI: 10.2459/jcm.0000000000000742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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5
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Xu N, Tang XF, Yao Y, Zhao XY, Chen J, Gao Z, Qiao SB, Yang YJ, Gao RL, Xu B, Yuan JQ. Association of Plasma Lipoprotein(a) With Long-Term Adverse Events in Patients With Chronic Kidney Disease Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2018; 122:2043-2048. [PMID: 30477725 DOI: 10.1016/j.amjcard.2018.04.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 01/17/2023]
Abstract
We aimed to determine the association of plasma lipoprotein(a) (Lp[a]) with long-term clinical outcomes in patients with chronic kidney disease (CKD) after percutaneous coronary intervention (PCI) in an observational cohort study. Four hundred and twenty-seven consecutive patients with CKD who underwent PCI from January 2013 to December 2013 were included in this study. Patients were divided into 2 groups according to median levels of Lp(a). Outcomes included 2-year risk of major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding according to Bleeding Academic Research Consortium definitions. Overall, median of Lp(a) in all the patients was 217.8 mg/L. The 2-year MACCE rate across the high Lp(a) and low Lp(a) group was 23.0% versus 15.4% (p = 0.047) and bleeding event rate of the two groups 8.9% versus 4.2% (p = 0.049). The Lp(a) was significantly and positively correlated with high-sensitivity C-reactive protein levels (r2 = 0.03, p < 0.001). Kaplan-Meier curves revealed that high Lp(a) had higher incidence of bleeding than low Lp(a) (p = 0.043) and had higher risk of MACCE (p = 0.049). Multivariable Cox regression analysis indicated that high Lp(a) was an independent predictor of Bleeding Academic Research Consortium bleeding compared with low Lp(a) (hazard ratios 2.29, 95% confidence intervals 1.01 to 5.15, p = 0.046). In conclusion, a high Lp(a) value may be associated with a poor prognosis after PCI for patients with CKD.
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6
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Drug eluting stents are superior to bare metal stents to reduce clinical outcome and stent-related complications in CKD patients, a systematic review, meta-analysis and network meta-analysis. J Interv Cardiol 2017; 31:319-329. [DOI: 10.1111/joic.12473] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 12/29/2022] Open
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7
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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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Abstract
First-generation drug-eluting stents significantly improved treatment of coronary disease, decreasing rates of revascularization. This was offset by high rates of late adverse events, driven primarily by stent thrombosis. Research and design improvements of individual DES platform components led to next-generation devices with superior clinical safety and efficacy profiles compared with bare-metal stents and first-generation drug-eluting stents. These design improvements and features are explored, and their resulting clinical safety and efficacy reviewed, focusing on platforms approved by the Food and Drug Administration currently widely used in the United States.
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Affiliation(s)
- Ramon A Partida
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB-800 Boston, MA 02114, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, E25-438, Cambridge, MA 02139, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Robert W Yeh
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Medicine, Smith Center for Outcomes Research in Cardiology, CardioVascular Institute, Beth Israel Medical Center, 330 Brookline Avenue, Baker 4, Boston, MA 02215, USA; Harvard Clinical Research Institute, Boston, MA, USA.
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9
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Abstract
First-generation drug-eluting stents significantly improved treatment of coronary disease, decreasing rates of revascularization. This was offset by high rates of late adverse events, driven primarily by stent thrombosis. Research and design improvements of individual DES platform components led to next-generation devices with superior clinical safety and efficacy profiles compared with bare-metal stents and first-generation drug-eluting stents. These design improvements and features are explored, and their resulting clinical safety and efficacy reviewed, focusing on platforms approved by the Food and Drug Administration currently widely used in the United States.
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10
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Drug-Eluting Stents Versus Bare Metal Stents for Percutaneous Coronary Intervention in Kidney Transplant Recipients. Transplantation 2017; 101:851-857. [PMID: 27517730 DOI: 10.1097/tp.0000000000001446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The comparative effectiveness of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus bare metal stents (BMS) has not been studied in the kidney transplant population. METHODS Using the US Renal Data System, we identified 3245 kidney transplant patients who underwent PCI between April 2003 and December 2010; 2400 and 845 patients received DES and BMS, respectively. We used propensity score matching and inverse probability of treatment weighting to create DES- and BMS-treated groups whose observed baseline characteristics were well-balanced. The associations between stent type and the outcomes of (1) death; (2) death or myocardial infarction (MI); (3) death, MI, or repeat revascularization (RR); and (4) hospitalized bleeding were compared using Cox proportional hazards regression. RESULTS Drug-eluting stent use increased during the study period, mirroring the trend described in the general population. In the propensity score-matched cohort, no significant association among DES (vs BMS) use and outcomes was observed at 1 and 2 years of follow-up. However, at 3 years, DES was associated with 20% (95% confidence interval [CI], 4-33%) lower risk of death, 15% (95% CI, 1-27%) lower risk of death or MI, and 14% (95% CI, 2-24%) lower risk of death, MI, or repeat revascularization. There were no significant differences in rates of hospitalized bleeding at any time point. Results were similar in the inverse probability of treatment weighting analysis. CONCLUSIONS In this retrospective study of US kidney transplant recipients undergoing PCI, DES was associated with better clinical outcomes beyond 2 years of follow-up.
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11
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Roberts JK, Rao SV, Shaw LK, Gallup DS, Marroquin OC, Patel UD. Comparative Efficacy of Coronary Revascularization Procedures for Multivessel Coronary Artery Disease in Patients With Chronic Kidney Disease. Am J Cardiol 2017; 119:1344-1351. [PMID: 28318510 DOI: 10.1016/j.amjcard.2017.01.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 12/18/2022]
Abstract
Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease and death, yet little data exist regarding the comparative efficacy of coronary revascularization procedures in CKD patients with multivessel disease. We created a cohort of 4,687 adults who underwent cardiac catheterization, had a serum creatinine value measured within 30 days, and had more than one vessel with ≥50% stenosis. We used Cox proportional hazard regression modeling weighted by the inverse probability of treatment to examine the association between 4 treatment strategies (medical management, percutaneous coronary intervention [PCI] with bare metal stent, PCI with drug-eluting stent, and coronary artery bypass grafting [CABG]) and mortality among patients across categories of estimated glomerular filtration rate; secondary outcome was a composite of mortality, myocardial infarction, or revascularization. Compared with medical management, CABG was associated with a reduced risk of death for patients of any nondialysis CKD severity (hazard ratio [HR] range 0.43 to 0.59). There were no significant mortality differences between CABG and PCI, except a decreased death risk in CABG-treated CKD patients (HR range 0.54 to 0.55). Compared with medical management and PCI, CABG was associated with a lower risk of death, myocardial infarction, or revascularization in nondialysis CKD patients (HR range 0.41 to 0.64). There were similar associations between decreased estimated glomerular filtration rate and increased mortality across all multivessel coronary artery disease patient treatment groups. When accounting for treatment propensity, surgical revascularization was associated with improved outcomes in patients of all CKD severities. A prospective randomized trial in CKD patients is required to confirm our findings.
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12
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Mathew RO, Bangalore S, Lavelle MP, Pellikka PA, Sidhu MS, Boden WE, Asif A. Diagnosis and management of atherosclerotic cardiovascular disease in chronic kidney disease: a review. Kidney Int 2016; 91:797-807. [PMID: 28040264 DOI: 10.1016/j.kint.2016.09.049] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 02/02/2023]
Abstract
Patients with chronic kidney disease (CKD) have a high prevalence of atherosclerotic cardiovascular disease, likely reflecting the presence of traditional risk factors. A greater distinguishing feature of atherosclerotic cardiovascular disease in CKD is the severity of the disease, which is reflective of an increase in inflammatory mediators and vascular calcification secondary to hyperparathyroidism of renal origin that are unique to patients with CKD. Additional components of atherosclerotic cardiovascular disease that are prominent in patients with CKD include microvascular disease and myocardial fibrosis. Therapeutic interventions that minimize cardiovascular events related to atherosclerotic cardiovascular disease in patients with CKD, as determined by well-designed clinical trials, are limited to statins. Data are lacking regarding other available therapeutic measures primarily due to exclusion of patients with CKD from major trials studying cardiovascular disease. Data from well-designed randomized controlled trials are needed to guide clinicians who care for this high-risk population in the management of atherosclerotic cardiovascular disease to improve clinical outcomes.
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Affiliation(s)
- Roy O Mathew
- Division of Nephrology, Department of Medicine, WJB Dorn VA Medical Center, Columbia, South Carolina, USA.
| | - Sripal Bangalore
- Division of Cardiology, New York University School of Medicine, New York, New York, USA
| | | | | | - Mandeep S Sidhu
- Division of Cardiology, Department of Medicine, Stratton VA Medical Center, Albany, New York, USA; Division of Cardiology, Department of Medicine, Albany Medical College, Albany, New York, USA
| | - William E Boden
- Division of Cardiology, Department of Medicine, Stratton VA Medical Center, Albany, New York, USA; Division of Cardiology, Department of Medicine, Albany Medical College, Albany, New York, USA
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Neptune, New Jersey, USA
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13
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Lu R, Tang F, Zhang Y, Zhu X, Zhu S, Wang G, Jiang Y, Fan Z. Comparison of Drug-Eluting and Bare Metal Stents in Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta-Analysis. J Am Heart Assoc 2016; 5:e003990. [PMID: 27821401 PMCID: PMC5210359 DOI: 10.1161/jaha.116.003990] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/30/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Drug-eluting stents (DESs) and bare metal stents (BMSs) are both recommended to improve coronary revascularization and to treat coronary artery disease in patients with chronic kidney disease (CKD). However, the potential superiority of DESs over BMSs for reducing the incidence of long-term major adverse cardiovascular events and mortality in CKD patients has not been established, and the results remain controversial. We aimed to systematically assess and quantify the total weight of evidence regarding the use of DESs versus BMSs in CKD patients. METHODS AND RESULTS In this systematic review and conventional meta-analysis, electronic studies published in any language until May 20, 2016, were systematically searched through PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials and observational studies comparing outcomes in CKD patients with DESs versus BMSs and extracted data in a standard form. Pooled odd ratios and 95% CIs were calculated using random- and fixed-effects models. Finally, 38 studies involving 123 396 patients were included. The use of DESs versus BMSs was associated with significant reductions in major adverse cardiovascular events (pooled odds ratio 0.75; 95% CI, 0.64-0.88; P<0.001), all-cause mortality (odds ratio 0.81; 95% CI, 0.73-0.90; P<0.001), myocardial infarction, target-lesion revascularization, and target-vessel revascularization. The superiority of DESs over BMSs for improving clinical outcomes was attenuated in randomized controlled trials. CONCLUSIONS The use of DESs significantly improves the above outcomes in CKD patients. Nevertheless, large-sized randomized controlled trials are necessary to determine the real effect on CKD patients and whether efficacy differs by type of DES.
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Affiliation(s)
- Renjie Lu
- Department of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, China
| | - Fenglei Tang
- Department of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, China
| | - Yan Zhang
- Department of Internal Medicine, The Third People's Hospital of Changzhou, Jiangsu, China
| | - Xishan Zhu
- Department of Urinary Surgery, The Third People's Hospital of Changzhou, Jiangsu, China
| | - Shanmei Zhu
- Department of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, China
| | - Ganlin Wang
- Department of Urinary Surgery, The Third People's Hospital of Changzhou, Jiangsu, China
| | - Yinfeng Jiang
- Department of Urinary Surgery, The Third People's Hospital of Changzhou, Jiangsu, China
| | - Zhengda Fan
- Department of Pharmacy, The Third People's Hospital of Changzhou, Jiangsu, China
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14
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Bhatti NK, Karimi Galougahi K, Paz Y, Nazif T, Moses JW, Leon MB, Stone GW, Kirtane AJ, Karmpaliotis D, Bokhari S, Hardy MA, Dube G, Mohan S, Ratner LE, Cohen DJ, Ali ZA. Diagnosis and Management of Cardiovascular Disease in Advanced and End-Stage Renal Disease. J Am Heart Assoc 2016; 5:JAHA.116.003648. [PMID: 27491836 PMCID: PMC5015288 DOI: 10.1161/jaha.116.003648] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Navdeep K Bhatti
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY
| | - Keyvan Karimi Galougahi
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY
| | - Yehuda Paz
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY
| | - Tamim Nazif
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY Cardiovascular Research Foundation, New York, NY
| | - Jeffrey W Moses
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY Cardiovascular Research Foundation, New York, NY
| | - Martin B Leon
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY Cardiovascular Research Foundation, New York, NY
| | - Gregg W Stone
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY Cardiovascular Research Foundation, New York, NY
| | - Ajay J Kirtane
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY Cardiovascular Research Foundation, New York, NY
| | - Dimitri Karmpaliotis
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY Cardiovascular Research Foundation, New York, NY
| | - Sabahat Bokhari
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY
| | - Mark A Hardy
- Department of Surgery, New York Presbyterian Hospital and Columbia University, New York, NY
| | - Geoffrey Dube
- Division of Nephrology, New York Presbyterian Hospital and Columbia University, New York, NY
| | - Sumit Mohan
- Division of Nephrology, New York Presbyterian Hospital and Columbia University, New York, NY
| | - Lloyd E Ratner
- Department of Surgery, New York Presbyterian Hospital and Columbia University, New York, NY
| | - David J Cohen
- Division of Nephrology, New York Presbyterian Hospital and Columbia University, New York, NY
| | - Ziad A Ali
- Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY Cardiovascular Research Foundation, New York, NY
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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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16
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Crimi G, Leonardi S, Costa F, Adamo M, Ariotti S, Valgimigli M. Role of stent type and of duration of dual antiplatelet therapy in patients with chronic kidney disease undergoing percutaneous coronary interventions. Is bare metal stent implantation still a justifiable choice? A post-hoc analysis of the all comer PRODIGY trial. Int J Cardiol 2016; 212:110-7. [PMID: 27038714 DOI: 10.1016/j.ijcard.2016.03.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/04/2016] [Accepted: 03/13/2016] [Indexed: 11/19/2022]
Abstract
AIM Chronic kidney disease (CKD) is a powerful predictor of major cardiovascular events and stent thrombosis (ST) in patients undergoing percutaneous coronary interventions (PCI). No randomized data are available to compare, and guide the selection of type of stent between bare metal (BMS) or drug eluting stent (DES) in this population. METHODS AND RESULTS We performed a post-hoc analysis of the PROlonging Dual antiplatelet treatment after Grading stent-induced Intimal hyperplasia studY (PRODIGY) trial, in which stable or unstable patients with coronary artery disease undergoing PCI were randomized 1:1:1:1 to receive BMS, paclitaxel- (PES), zotarolimus- (ZES-S), or everolimus- (EES) eluting stent. A total of 2003 patients were randomized, and 22 patients were excluded for missing serum creatinine leading to a final population of 1981 patients. Primary outcome was definite or probable ST. We also assessed MACE (myocardial infarction, stroke, or death), and all-cause death, as secondary outcome. CKD, defined with estimated glomerular filtration rate <60ml/min/1.73m(2), was found in 373 patients (18.8%). The incidence of ST at 2years was 5.1% in CKD and 2.1% in non-CKD patients (HR 2.57, 95% confidence interval (CI) 1.46 to 4.52, p<0.001). At multivariable regression we found that patients randomized to EES or ZES-S, but not PES, had lower risk of ST at two years as compared with BMS: adjusted HR=0.288, 95% CI [0.107-0.778, p=0.014] and HR=0.394, 95% CI [0.164-0.947, p=0.037] respectively. The number of patients needed to be treated to prevent 1 ST with an EES vs BMS was 20 in CKD and 50 in patients without CKD. EES patients had the lowest incident MACE events 26.4% as compared to BMS 35.1%, ZES-S 33.0%, or PES 35.7% patients, p=0.551. All-cause death was lowest in ZES-S group 10.6% as compared to BMS 18.1%, PES 25.5% and EES 14.9%, p=0.040. We found no significant interaction between DAPT duration (6 vs 24months) and stent type on primary outcome, PINT=0.47 for BMS, PINT=0.57 for PES, PINT=0.41 for ZES-S and PINT=0.28 for EES. CONCLUSIONS In an all-comer population of patients with stable and unstable CAD, CKD at baseline was associated with a double risk of ST and MACE. CKD patients receiving EES had less than half risk of ST 2years after PCI as compared with BMS and PES. Our analysis suggests that 2nd generation limus-based stent should be favored over paclitaxel-based DES or BMS to reduce ST and MACE in CKD patients.
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Affiliation(s)
- Gabriele Crimi
- SC. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sergio Leonardi
- SC. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Baber U, Giustino G, Sartori S, Aquino M, Stefanini GG, Steg PG, Windecker S, Leon MB, Wijns W, Serruys PW, Valgimigli M, Stone GW, Dangas GD, Morice MC, Camenzind E, Weisz G, Smits PC, Kandzari D, Von Birgelen C, Mastoris I, Galatius S, Jeger RV, Kimura T, Mikhail GW, Itchhaporia D, Mehta L, Ortega R, Kim HS, Kastrati A, Chieffo A, Mehran R. Effect of Chronic Kidney Disease in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents. JACC Cardiovasc Interv 2016; 9:28-38. [DOI: 10.1016/j.jcin.2015.09.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/05/2015] [Accepted: 09/10/2015] [Indexed: 11/26/2022]
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18
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Loncar G, Barthelemy O, Berman E, Kerneis M, Petroni T, Payot L, Choussat R, Silvain J, Collet JP, Helft G, Montalescot G, Le Feuvre C. Impact of renal failure on all-cause mortality and other outcomes in patients treated by percutaneous coronary intervention. Arch Cardiovasc Dis 2015; 108:554-62. [DOI: 10.1016/j.acvd.2015.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/11/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
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19
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Roberts JK, McCullough PA. The management of acute coronary syndromes in patients with chronic kidney disease. Adv Chronic Kidney Dis 2014; 21:472-9. [PMID: 25443572 DOI: 10.1053/j.ackd.2014.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/13/2014] [Accepted: 08/25/2014] [Indexed: 11/11/2022]
Abstract
Coronary heart disease is highly prevalent in patients with CKD, and survival after acute coronary syndrome (ACS) is worse compared with the general population. Many trials that define guidelines for cardiovascular disease excluded patients with kidney disease, leaving a gap between the evidence base and clinical reality. The underlying pathophysiology of vascular disease appears to be different in the setting of CKD. Patients with CKD are more likely to present with myocardial infarction and less likely to be diagnosed with ACS on admission compared with the general population. Patients with CKD appear to benefit with angiography and revascularization compared with medical management alone. However, the increased risk of in-hospital bleeding and risk of contrast-induced acute kidney injury are 2 factors that can limit overall benefit for some. Thus, judicious application of available therapies for the management of ACS is warranted to extend survival and reduce hospitalizations in this high-risk population. In this review, we highlight the clinical challenges and potential solutions for managing ACS in patients with CKD.
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20
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Cai Q, Mukku VK, Ahmad M. Coronary artery disease in patients with chronic kidney disease: a clinical update. Curr Cardiol Rev 2014; 9:331-9. [PMID: 24527682 PMCID: PMC3941098 DOI: 10.2174/1573403x10666140214122234] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 11/27/2013] [Accepted: 12/04/2013] [Indexed: 01/07/2023] Open
Abstract
Chronic kidney disease (CKD) is an independent risk factor for coronary artery disease (CAD). Coronary artery
disease is the leading cause of morbidity and mortality in patients with CKD. The outcomes of CAD are poorer in patients
with CKD. In addition to traditional risk factors, several uremia-related risk factors such as inflammation, oxidative stress,
endothelial dysfunction, coronary artery calcification, hyperhomocysteinemia, and immunosuppressants have been associated
with accelerated atherosclerosis. A number of uremia-related biomarkers are identified as predictors of cardiac outcomes
in CKD patients. The symptoms of CAD may not be typical in patients with CKD. Both dobutamine stress echocardiography
and radionuclide myocardial perfusion imaging have moderate sensitivity and specificity in detecting obstructive
CAD in CKD patients. Invasive coronary angiography carries a risk of contrast nephropathy in patients with advanced
CKD. It should be reserved for those patients with a high risk for CAD and those who would benefit from revascularization.
Guideline-recommended therapies are, in general, underutilized in renal patients. Medical therapy should be
considered the initial strategy for clinically stable CAD. The effects of statins in patients with advanced CKD have been
neutral despite a lipid-lowering effect. Compared to non-CKD population, percutaneous coronary intervention (PCI) is associated
with higher procedure complications, restenosis, and future cardiac events even in the drug-eluting stent era in
patients with CKD. Compared with PCI, coronary artery bypass grafting (CABG) reduces repeat revascularizations but is
associated with significant perioperative morbidity and mortality. Screening for CAD is an important part of preoperative
evaluation for kidney transplant candidates.
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Affiliation(s)
| | | | - Masood Ahmad
- Department of Cardiology, McFarland Clinic, 1215 Duff Avenue, Ames, IA 50010.
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21
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Wang ZJ, Harjai KJ, Shenoy C, Gao F, Shi DM, Liu YY, Zhao YX, Zhou YJ. Drug-Eluting Stents Versus Bare-Metal Stents in Patients With Decreased GFR: A Meta-analysis. Am J Kidney Dis 2013; 62:711-21. [DOI: 10.1053/j.ajkd.2013.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 04/23/2013] [Indexed: 11/11/2022]
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22
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Wang SP, Huang RC, Zhu H, Zhang B, Zheng ZG, Yin DA, Wang JJ, Zhou XC. Safety and efficacy of a non-polymeric paclitaxel-eluting microporous stent in real-world percutaneous coronary intervention. Exp Ther Med 2013; 6:811-815. [PMID: 24137271 PMCID: PMC3786829 DOI: 10.3892/etm.2013.1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 06/21/2013] [Indexed: 11/05/2022] Open
Abstract
At present, there is an increasing focus on stents that have a biodegradable polymer coating, rather than a permanent polymer coating. This is due to the fact that following the implantation of a drug-eluting stent (DES) with a permanent polymer coating, the continued existence of the coating may result in a foreign body reaction and delayed re-endothelialization. The aim of the present study was to evaluate the safety and efficacy of a non-polymeric paclitaxel-eluting microporous (YINYI™) stent in real-life percutaneous coronary intervention (PCI) for patients with coronary artery disease (CAD). A total of 686 YINYI™ stents were implanted in 404 patients with CAD in a PCI procedure and outpatient follow-ups were performed 1, 6, 12 and 15 months subsequent to the PCI, respectively. The observation endpoints were major adverse cardiac events (MACEs), including cardiac death, non-fatal myocardial infarction (MI), restenosis, target lesion revascularization, stent thrombosis and recurrence of angina pectoris. The average follow-up time was 15 months. The results revealed that the cumulative incidences of MACEs were as follows: mortality, 0.99%; non-fatal MI, 0.74%; restenosis, 4.0%; and target lesion revascularization, 2.7%. The results at the short- and long-term clinical follow-ups indicated that YINYI™ stents are effective and safe for use in PCI for patients with CAD.
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Affiliation(s)
- Shao-Peng Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
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Abstract
The burden of cardiovascular disease is high in patients with chronic kidney disease or end-stage renal disease. The presence of kidney dysfunction affects the cardiovascular system in multiple ways, including accelerated progression of atherosclerosis and valvular disease, the exacerbation of congestive heart failure, and the development of pericardial disease. This comorbidity results not only from the concordance of shared risk factors, but also from other issues specific to this population, such as systemic inflammation and vascular calcification. Furthermore, both the sensitivity and specificity of noninvasive testing modalities, and the efficacy of several pharmacotherapeutic strategies, are diminished in this population. The exclusion of patients with severe kidney disease from many clinical trials of cardiac interventions raises various therapeutic uncertainties, and kidney disease itself is likely to alter the underlying cardiovascular physiology. In this Review, we discuss aspects of the epidemiology, pathophysiology, and diagnosis of cardiovascular disease in patients with kidney disease, and propose specific, evidence-based recommendations for pharmacological and surgical treatment.
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Donahue M, Briguori C. Stent thrombosis in patients with chronic kidney disease. Expert Rev Cardiovasc Ther 2012; 10:617-26. [PMID: 22651837 DOI: 10.1586/erc.12.45] [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] [Indexed: 11/08/2022]
Abstract
Chronic kidney disease is a strong predictor of adverse cardiac events, including death, myocardial infarction and stent thrombosis (ST), after percutaneous coronary intervention. In the past few years, the development of new therapeutic strategies (including both drugs and devices) and a more complete understanding of the pathophysiology and predictive factors of thrombosis have led to a significant reduction of this complication. Despite this, ST still remains a dramatic event due to its morbidity and mortality. Further efforts should be pursued to identify patients at high risk of ST in order to adopt a more effective preventive strategy. This review sought to examine the total weight of evidence regarding ST with the use of drug-eluting stents in patients with chronic kidney disease.
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Affiliation(s)
- Michael Donahue
- Laboratory of Interventional Cardiology, Clinica Mediterranea, Naples, Italy
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