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How does clinical profile and outcome differ in patients with Chronic Kidney Disease undergoing percutaneous coronary revascularization according to the severity of CKD? - CHANNEL Study. Indian Heart J 2021; 73:476-480. [PMID: 34474761 PMCID: PMC8424264 DOI: 10.1016/j.ihj.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/28/2021] [Accepted: 06/16/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease. We evaluated outcomes amongst patients of CKD undergoing percutaneous coronary intervention (PCI) as assessed on severity of CKD based on estimated glomerular filtration rate (eGFR) at the time of PCI. METHOD AND MATERIALS We analyzed 100 consecutive CKD patients who underwent PCI and were followed up for 1 year; an observational, prospective, open-label study. Multivariate and Receiver operator characteristics (ROC) analysis was used to determine the cut point ofeGFR for predicting 4-P major adverse cardiac events (MACE) outcomes defined as the composite of Cardiovascular (CV) mortality, heart failure hospitalization (HHF), repeat revascularization and non-fatal MI over 1 year follow up. RESULTS According to eGFR cut-off value derived from ROC, patients were divided in to two groups based on eGFR cut-off of 36.25 mL/min/1.73 m2. Majority of patients (79%) were in Group 1 (eGFR >36.25 mL/min/1.73 m2). Group 2 had Lower HbA1C, hemoglobin and elevated level of urea as compared to group:1 (p=0.002,<0.0001 respectively). All-cause mortality had trend forbeing higher (6.3 vs. 19%) in group:2, but statistically non-significant (p = 0.17). Lower baseline LVEF (39 ± 10.08%) across the cohort was independent predictor of higher risk for HHF. eGFR <36.25 mL/mim/1.73 m2 was the most robust predictor of MACE, carrying a 3-fold increase in risk of 4-P MACE with significant association (0.69, CI 0.59 to 0.78, p = 0.0009). CONCLUSIONS Lower baseline eGFR was associated with higher incidence of 4 P MACE with best cut-off being eGFR <36.25 mL/min/1.73 m2. Lower Baseline LVEF was independent predictor from HHF across the cohort.
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Mehta A, Tahhan AS, Liu C, Dhindsa DS, Nayak A, Hooda A, Moazzami K, Islam SJ, Rogers SC, Almuwaqqat Z, Mokhtari A, Hesaroieh I, Ko YA, Waller EK, Quyyumi AA. Circulating Progenitor Cells in Patients With Coronary Artery Disease and Renal Insufficiency. JACC Basic Transl Sci 2020; 5:770-782. [PMID: 32875168 PMCID: PMC7452291 DOI: 10.1016/j.jacbts.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 10/26/2022]
Abstract
Patients with coronary artery disease and renal insufficiency (RI) (estimated glomerular filtration rate <60 ml/min/1.73 m2) are at an increased risk of cardiovascular events. The contribution of regenerative capacity, measured as circulating progenitor cell (CPC) counts, to this increased risk is unclear. CPCs were enumerated as cluster of differentiation (CD) 45med+ mononuclear cells expressing CD34+, CD133+, CXCR4+ (chemokine [C-X-C motif] receptor 4), and VEGF2R+ (vascular endothelial growth factor receptor 2) epitopes in 1,281 subjects with coronary artery disease (35% with RI). Patients with RI and low (<median) hematopoietic CPCs (CD34+, CD34+/CD133+, and CD34+/CXCR4+) were at an increased risk of cardiovascular death or myocardial infarction events (hazard ratios: 1.75 to 1.80) during 3.5-year follow-up, while those with RI and high CPCs (>median) were at a similar risk as those without RI.
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Key Words
- BNP, B-type natriuretic peptide
- CAD, coronary artery disease
- CD, cluster of differentiation
- CI, confidence interval
- CPC, circulating progenitor cell
- CV, cardiovascular
- CXCR4, chemokine (C-X-C motif) receptor 4
- HR, hazard ratio
- IDI, integrated discrimination index
- MI, myocardial infarction
- VEGF2R, vascular endothelial growth factor receptor 2
- coronary artery disease
- eGFR, estimated glomerular filtration rate
- hsTnI, high-sensitivity troponin I
- outcomes
- progenitor cells
- regenerative capacity
- renal insufficiency
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Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ayman S Tahhan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chang Liu
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Devinder S Dhindsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Aditi Nayak
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ananya Hooda
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kasra Moazzami
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shabatun J Islam
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Steven C Rogers
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zakaria Almuwaqqat
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ali Mokhtari
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Iraj Hesaroieh
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Yi-An Ko
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Edmund K Waller
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Aktürk E, Aşkın L, Taşolar H, Kurtoğlu E, Türkmen S, Tanrıverdi O, Uzel KE. Evaluation of contrast nephropathy in percutaneous treatment of chronic total occlusions. Interv Med Appl Sci 2020; 11:95-100. [PMID: 32148912 PMCID: PMC7044539 DOI: 10.1556/1646.11.2019.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Contrast-induced nephropathy (CIN) is a leading cause of morbidity and mortality in patients undergoing percutaneous coronary intervention (PCI). Chronic total occlusions (CTO) are frequently observed among patients undergoing coronary angiography. Methods A total of 128 CTO patients were included. Mehran score, lesion characteristics, interventional procedure, serological specimens and devices were recorded. The first group was administered with 1 ml · kg-1 · h-1 saline (0.9% NaCl) infusion that started 12 h before the procedure and continued 12 h post procedure as recommended by the guidelines. The second group was administered with saline infusion of 12 ml · kg-1 · h-1 only during CTO-PCI procedure, which is called as intensive infusion. Results CIN development was similar in two groups (four patients in standard hydration group and five patients in intensive hydration group). The amount of saline was significantly higher in the standard group (1,767 ± 192.2 vs. 1,043.6 ± 375; p < 0.001). Patients with higher creatinine levels prior to PCI had a higher rate of CIN development after procedure. Interestingly, age, left ventricular ejection fraction, and diabetes mellitus independently predicted CIN. Conclusion Intensive hydration administration appears to be an effective and cost-effective method in CTO-PCI patients, especially in patients without left ventricular function failure.
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Affiliation(s)
- Erdal Aktürk
- Faculty of Medicine, Department of Cardiology, Adiyaman University, Adiyaman, Turkey
| | - Lütfü Aşkın
- Faculty of Medicine, Department of Cardiology, Adiyaman University, Adiyaman, Turkey
| | - Hakan Taşolar
- Faculty of Medicine, Department of Cardiology, Inönü University, Malatya, Turkey
| | - Ertuğrul Kurtoğlu
- Department of Cardiology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Serdar Türkmen
- Faculty of Medicine, Department of Cardiology, Adiyaman University, Adiyaman, Turkey
| | - Okan Tanrıverdi
- Faculty of Medicine, Department of Cardiology, Adiyaman University, Adiyaman, Turkey
| | - Kader Eliz Uzel
- Faculty of Medicine, Department of Cardiology, Adiyaman University, Adiyaman, Turkey
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Chala G, Sisay T, Teshome Y. Chronic Kidney Disease And Associated Risk Factors Among Cardiovascular Patients. Int J Nephrol Renovasc Dis 2019; 12:205-211. [PMID: 31571971 PMCID: PMC6757142 DOI: 10.2147/ijnrd.s223196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/07/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Chronic kidney diseases (CKDs) are known in patients with cardiovascular diseases (CVDs) and cause extra morbidity and mortality. There were few related studies in Africa, and no such studies exist in Ethiopia. OBJECTIVE To determine the magnitude of chronic kidney disease and associated risk factors among cardiovascular (CV) patients. METHODS A cross-sectional study was conducted on randomly selected 163 CV patients attending Tikur-Anbessa Specialized Hospital (TASH), Ethiopia. Estimated glomerular filtration rate (GFR) was determined using the Simplified Modification of Diet in Renal Disease (MDRD) equation. Body weight, height, and blood pressure were recorded, and body mass index (BMI) was calculated. Serum urea and creatinine were analyzed using an automatic analyzer (MINDRAY, BE-2000), and blood urea nitrogen (BUN) was calculated. RESULTS In this study, CKD, defined as estimated GFR (eGFR) < 60 mL/min/1.73m2 was found in 39 (23.9%) participants using the MDRD equation. Normal serum creatinine (SCr) was observed in 114 (69.9%) participants and proteinuria was found in 41 (25.2%) participants. CKD was significantly associated with systolic blood pressure (COR: -0.240, 95% CI: -0.439 to -0.041, p = 0.018), SCr (COR: -0.679; 95% CI: -0.778 to -0.580; p = 0.001) and BUN (COR: -0.422; 95% CI: -0.550 to -0.295; p = 0.001). In multivariate analysis, only high SCr (AOR = 47.57; 95% CI: 13.72-164.89; p = 0.001) was independently associated with CKD. CONCLUSION These findings indicated that the CKD was significantly associated with SBP and increased BUN, while independently associated with increased SCr. Thus, early detection and recognition of CKD in-patient with CVD helps to avoid extra morbidity and mortality. We recommend using the MDRD formula in health facilities for diagnosing of CKD to reduce duplication of laboratory tests (SCr and BUN), as it is the easiest practice and saves patients and the public sector costs.
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Affiliation(s)
- Getahun Chala
- Department of Medical Physiology, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tariku Sisay
- Department of Biomedical Science, College of Health Sciences, Mizan Tepi University, Mizan, Ethiopia
| | - Yonas Teshome
- Department of Biomedical Sciences, College of Medicine, Debre Berhan University, Debre Berhan, Ethiopia
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Song F, Sun G, Liu J, Chen JY, He Y, Chen S, Chen G, Tan N, Liu Y. The association between post-procedural oral hydration and risk of contrast-induced acute kidney injury among ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:321. [PMID: 31475191 DOI: 10.21037/atm.2019.06.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Oral hydration with water may be inexpensive and effective in the prevention of contrast-induced acute kidney injury (CI-AKI), but its efficacy among ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains unknown. Methods This was a prospective, single-center, observational study. We consecutively enrolled 308 STEMI patients undergoing primary PCI. All patients drank unrestricted amounts of fluids freely, whose volume was recorded until 24 hours following primary PCI. Oral hydration volume/weight ratios (OHV/W) were calculated. Adequate oral hydration was defined as a ratio over 12 mL/kg within 24 hours after primary PCI. The primary outcome measure was CI-AKI, defined as a 25% or 0.5 mg/dL increase in serum creatinine from baseline during the first 48-72 hours post-procedure. The association between adequate post-procedural oral hydration and CI-AKI was assessed using multivariable logistic analysis. Results Post-procedural prophylactic oral hydration was implemented in 90.91% (280/308) of STEMI patients undergoing primary PCI. There were no differences in the sex, age, weight, index blood pressure, LVEF, anemia, diabetes mellitus, contrast volume used during the coronary procedures between groups (P>0.05). The incidence of CI-AKI was much higher in the inadequate oral hydration group (<12 mL/kg) than the adequate group (≥12 mL/kg) (53.57% vs. 21.79%, P=0.0002). Multivariate logistic regression showed adequate oral hydration (≥12 mL/kg) was the independent protective factor associated with CI-AKI (OR =0.349, 95% CI: 0.147-0.828, P=0.0170), after adjusting confounders, including age, female gender, baseline serum creatinine, diabetes mellitus, use of diuretics, congestive heart failure and intravenous hydration volume. Conclusions Our study determined the association of post-procedural adequate oral hydration on CI-AKI following primary PCI, which was a potential strategy for CI-AKI prevention among patients with STEMI at very high risk.
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Affiliation(s)
- Feier Song
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Guoli Sun
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,School of Medicine, South China University of Technology, Guangzhou 510100, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yibo He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Guanzhong Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,School of Medicine, South China University of Technology, Guangzhou 510100, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
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6
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Song F, Sun G, Liu J, Chen JY, He Y, Liu L, Liu Y. Efficacy of post-procedural oral hydration volume on risk of contrast-induced acute kidney injury following primary percutaneous coronary intervention: study protocol for a randomized controlled trial. Trials 2019; 20:290. [PMID: 31133052 PMCID: PMC6537180 DOI: 10.1186/s13063-019-3413-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) contributes toward unfavorable clinical outcomes. Oral hydration with water is inexpensive and it may be effective in the prevention of CI-AKI, but its efficacy among patients undergoing primary percutaneous coronary intervention (PCI) remains unknown. METHODS/DESIGN Our study is a secondary analysis on the database from the ATTEMPT study. We enrolled ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI. Eligible patients received peri-procedural aggressive (left ventricular end-diastolic pressure-guided) or routine (≤ 500 mL) intravenous hydration with an isotonic solution (0.9% NaCl) with randomization. The primary endpoint was CI-AKI, defined as a > 25% or 0.5 mg/dL increase in serum creatinine from baseline during the first 48-72 h post-procedurally. All patients drank unrestricted amounts of fluids freely, the volume of which was recorded until 24 h following primary PCI. Oral hydration volume/weight (OHV/W) ratios were calculated. The association between post-procedural oral hydration (quartiles) and CI-AKI was assessed using multivariable analysis controlling for confounders, including intravenous hydration strategies. DISCUSSION Our study determined the effects of post-procedural oral hydration on CI-AKI following primary PCI, which is a potential strategy for CI-AKI prevention among patients with STEMI at very high risk. TRIAL REGISTRATION ClinicalTrials.gov, NCT02067195 . Registered on 21 February 2014.
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Affiliation(s)
- Feier Song
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Guoli Sun
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China.
| | - Yibo He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Liwei Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, People's Republic of China.
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Bianco V, Kilic A, Gleason TG, Aranda‐Michel E, Navid F, Sultan I. Longitudinal outcomes of dialysis‐dependent patients undergoing isolated coronary artery bypass grafting. J Card Surg 2019; 34:110-117. [DOI: 10.1111/jocs.13991] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/24/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Valentino Bianco
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
| | - Arman Kilic
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Thomas G. Gleason
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Edgar Aranda‐Michel
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
| | - Forozan Navid
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
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Cardiovascular Outcomes in Patients on Hemodialysis following Drug-Eluting versus Bare-Metal Coronary Stents. Cardiol Res Pract 2018; 2018:4934982. [PMID: 29887997 PMCID: PMC5985085 DOI: 10.1155/2018/4934982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/16/2018] [Accepted: 04/17/2018] [Indexed: 11/18/2022] Open
Abstract
Aim This study sought to compare short- and long-term outcomes of drug-eluting stents (DESs) versus bare-metal stents (BMSs) implantation in patients with end-stage renal disease on hemodialysis (ESRD-HD) undergoing percutaneous coronary intervention (PCI). Methods Adult patients with ESRD-HD who underwent PCI at all nonfederal hospitals in Massachusetts between July 1, 2003, and September 30, 2007, were stratified based on the stent type placed at index hospitalization: DES or BMS. The primary outcome compared was a composite of all-cause death, myocardial infarction (MI), congestive heart failure (CHF), target vessel revascularization (TVR), and stroke at 30 days and one year. Results HD patients had a high mortality (31%) and were more likely to receive a DES than a BMS (77% versus 23%). Propensity score analysis of 2 : 1 matched DES (268) versus BMS (134) patients demonstrated the DES group to more likely have proximal LAD disease and a history of prior PCI. Conditional logistic regression analysis demonstrated no significant difference in the composite cardiovascular endpoint measured at 30 days (hazard ratio (HR) 1.09; 95% confidence interval (CI) 0.61–1.94) and one year (HR 1.03; 95% CI 0.68–1.57). Conclusions There were no significant differences in 30-day or 1-year major cardiovascular outcomes in HD patients undergoing PCI using the DES compared to the BMS in this high-mortality patient cohort.
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9
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Rabani S, Sardarinia M, Akbarpour S, Azizi F, Khalili D, Hadaegh F. 12-year trends in cardiovascular risk factors (2002-2005 through 2011-2014) in patients with cardiovascular diseases: Tehran lipid and glucose study. PLoS One 2018; 13:e0195543. [PMID: 29768511 PMCID: PMC5955533 DOI: 10.1371/journal.pone.0195543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/23/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To examine the trend of cardiovascular diseases (CVD) risk factors among a Middle Eastern population with prevalent CVD during a median follow up of 12 years. METHODS Patients with prevalent CVD (n = 282, men = 167), with a mean age of 60.76 years were evaluated in four study phases of the TLGS (Tehran lipid glucose study), 2002-2005, 2005-2008, 2008-2011, and 2011-2014. Trends of CVD risk factors were estimated using generalized estimation equation (GEE) models, by adjusting for gender, age and propensity scores. RESULT The adjusted prevalence of general and central adiposity, diabetes and physical inactivity at baseline was 25.18, 60.14, 25.03 and 43.74%, respectively and had increasing trends during the study period, reaching 41.32, 66.74, 43.20 and 50.32%, respectively, at the last visit. Although systolic, but not diastolic blood pressure, decreased from 134.88 to 129.86 mmHg, the prevalence of hypertension did not decrease (64.21% vs 68%, p value = 0.326). The prevalence of low high density lipoprotein cholesterol (HDL-C), hypertriglyceridemia and high non-HDL-C at baseline was 74.54, 59.89 and 96.53%, respectively, and showed improved trends reaching 44.87, 47.12 and 96.06% respectively; however, the favorable trend was not observed for high low density cholesterol. Significant increasing trends were observed in the consumption of anti-hypertensive, lipid and glucose lowering medications, but not for aspirin. The prevalence of current smoking (11.05 vs 16.83%, p value = 0.042) and chronic kidney disease (44.16 vs 51.65%, p value = 0.054) increased during follow up. CONCLUSION Except for lipid profile status, dangerous trends for other CVD risk factors were demonstrated among CVD patients, which can be a harbinger for high rates of CVD mortality; these findings highlight the need for urgent implementation of multicomponent interventions to control CVD risk factors among these patients.
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Affiliation(s)
- SeyedHossein Rabani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Sardarinia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
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Miller-Hodges E, Anand A, Shah ASV, Chapman AR, Gallacher P, Lee KK, Farrah T, Halbesma N, Blackmur JP, Newby DE, Mills NL, Dhaun N. High-Sensitivity Cardiac Troponin and the Risk Stratification of Patients With Renal Impairment Presenting With Suspected Acute Coronary Syndrome. Circulation 2018; 137:425-435. [PMID: 28978551 PMCID: PMC5793996 DOI: 10.1161/circulationaha.117.030320] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/18/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND High-sensitivity cardiac troponin testing may improve the risk stratification and diagnosis of myocardial infarction, but concentrations can be challenging to interpret in patients with renal impairment, and the effectiveness of testing in this group is uncertain. METHODS In a prospective multicenter study of consecutive patients with suspected acute coronary syndrome, we evaluated the performance of high-sensitivity cardiac troponin I in those with and without renal impairment (estimated glomerular filtration rate <60mL/min/1.73m2). The negative predictive value and sensitivity of troponin concentrations below the risk stratification threshold (5 ng/L) at presentation were reported for a primary outcome of index type 1 myocardial infarction, or type 1 myocardial infarction or cardiac death at 30 days. The positive predictive value and specificity at the 99th centile diagnostic threshold (16 ng/L in women, 34 ng/L in men) was determined for index type 1 myocardial infarction. Subsequent type 1 myocardial infarction and cardiac death were reported at 1 year. RESULTS Of 4726 patients identified, 904 (19%) had renal impairment. Troponin concentrations <5 ng/L at presentation identified 17% of patients with renal impairment as low risk for the primary outcome (negative predictive value, 98.4%; 95% confidence interval [CI], 96.0%-99.7%; sensitivity 98.9%; 95%CI, 97.5%-99.9%), in comparison with 56% without renal impairment (P<0.001) with similar performance (negative predictive value, 99.7%; 95% CI, 99.4%-99.9%; sensitivity 98.4%; 95% CI, 97.2%-99.4%). The positive predictive value and specificity at the 99th centile were lower in patients with renal impairment at 50.0% (95% CI, 45.2%-54.8%) and 70.9% (95% CI, 67.5%-74.2%), respectively, in comparison with 62.4% (95% CI, 58.8%-65.9%) and 92.1% (95% CI, 91.2%-93.0%) in those without. At 1 year, patients with troponin concentrations >99th centile and renal impairment were at greater risk of subsequent myocardial infarction or cardiac death than those with normal renal function (24% versus 10%; adjusted hazard ratio, 2.19; 95% CI, 1.54-3.11). CONCLUSIONS In suspected acute coronary syndrome, high-sensitivity cardiac troponin identified fewer patients with renal impairment as low risk and more as high risk, but with lower specificity for type 1 myocardial infarction. Irrespective of diagnosis, patients with renal impairment and elevated cardiac troponin concentrations had a 2-fold greater risk of a major cardiac event than those with normal renal function, and should be considered for further investigation and treatment. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01852123.
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Affiliation(s)
- Eve Miller-Hodges
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
- Department of Renal Medicine, Royal Infirmary of Edinburgh, United Kingdom (E.M.-H., P.G., T.F., N.D.)
| | - Atul Anand
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
| | - Anoop S V Shah
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
| | - Andrew R Chapman
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
| | - Peter Gallacher
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
- Department of Renal Medicine, Royal Infirmary of Edinburgh, United Kingdom (E.M.-H., P.G., T.F., N.D.)
| | - Kuan Ken Lee
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
| | - Tariq Farrah
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
- Department of Renal Medicine, Royal Infirmary of Edinburgh, United Kingdom (E.M.-H., P.G., T.F., N.D.)
| | - Nynke Halbesma
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (N.H.)
| | - James P Blackmur
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
| | - David E Newby
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
| | - Nicholas L Mills
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
| | - Neeraj Dhaun
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, United Kingdom (E.M.-H., A.A., A.S.V.S., A.R.C., P.G., K.K.L., T.F., J.P.B., D.E.N., N.L.M., N.D.)
- Department of Renal Medicine, Royal Infirmary of Edinburgh, United Kingdom (E.M.-H., P.G., T.F., N.D.)
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Hori D, Yamaguchi A, Adachi H. Coronary Artery Bypass Surgery in End-Stage Renal Disease Patients. Ann Vasc Dis 2017; 10:79-87. [PMID: 29034031 PMCID: PMC5579782 DOI: 10.3400/avd.ra.17-00024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 12/21/2022] Open
Abstract
The number of patients requiring hemodialysis is continuously increasing around the world. Hemodialysis affects patient quality of life and it is also associated with a higher risk for cardiovascular events. In addition to traditional risk factors for cardiovascular events such as hypertension, hyperlipidemia, and diabetes, hemodialysis is associated with hyperphosphatemia, chronic inflammation, vascular calcification, and anemia which accelerate atherosclerosis, vascular stiffness, and cardiac ischemia. Treatment strategy for coronary revascularization in this progressive disease remains controversial. However, a systematic treatment including medical therapy and complete revascularization through a less invasive strategy should be considered in addressing this problem. This review discusses the epidemiology, vascular pathology and current treatment options in patients with end-stage renal disease requiring coronary revascularization.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
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12
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Chen YT, Chen HT, Hsu CY, Chao PW, Kuo SC, Ou SM, Shih CJ. Dual Antiplatelet Therapy and Clinical Outcomes after Coronary Drug-Eluting Stent Implantation in Patients on Hemodialysis. Clin J Am Soc Nephrol 2017; 12:262-271. [PMID: 28174317 PMCID: PMC5293329 DOI: 10.2215/cjn.04430416] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/19/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES We aimed to investigate the benefits and risks of dual antiplatelet therapy (DAPT) after coronary drug-eluting stent (DES) implantation in patients undergoing hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A nested case-control analysis of patients on hemodialysis after receipt of DES and DAPT treatment was conducted using data from Taiwan's National Health Insurance Research Database for the period 2007-2011. Cases of myocardial infarction or death within 1 year after DES implantation were matched one-to-one with control patients. Odds ratios were calculated to compare DAPT continuation with discontinuation. Additionally, a propensity score-adjusted 6-month landmark cohort analysis was also conducted to evaluate the long-term benefits and risks of prolonged (>6 months) compared with ≤6 months of DAPT use. The primary outcomes were death and myocardial infarction. The secondary outcomes were ischemic stroke, revascularization, and major bleeding. RESULTS In the nested case-control analysis, patients who continued DAPT had a lower rate of death or myocardial infarction within 1 year after receipt of a DES (adjusted odds ratio, 0.54; 95% confidence interval, 0.36 to 0.81; P=0.003), whereas this association became statistically nonsignificant when compared with patients who discontinued DAPT for the period between 6 and 12 months after receipt of a DES (adjusted odds ratio, 1.51; 95% confidence interval, 0.75 to 3.04). In the propensity score-adjusted cohort analysis, >6 months of DAPT use was not associated with different primary or secondary outcomes than shorter-term use. CONCLUSIONS Our findings support that the clinical effectiveness of extended DAPT in a hemodialysis population may be tempered after 6 months post-DES implantation.
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Affiliation(s)
- Yung-Tai Chen
- Divisions of *Nephrology and
- Institute of Clinical Medicine
| | - Hung-Ta Chen
- Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
- School of Medicine, and
| | - Chien-Yi Hsu
- Institute of Clinical Medicine
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- College of Medicine and
| | - Pei-Wen Chao
- College of Medicine and
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | | | - Shuo-Ming Ou
- Institute of Clinical Medicine
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; and
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Wiggins BS, Saseen JJ, Page RL, Reed BN, Sneed K, Kostis JB, Lanfear D, Virani S, Morris PB. Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e468-e495. [DOI: 10.1161/cir.0000000000000456] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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14
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Ohira S, Doi K, Numata S, Yamazaki S, Kawajiri H, Yaku H. Impact of Chronic Kidney Disease on Long-Term Outcome of Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus. Circ J 2016; 80:110-117. [DOI: 10.1253/circj.cj-15-0776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Suguru Ohira
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Kiyoshi Doi
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hidetake Kawajiri
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
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Malleshappa P, Shah BV. Prevalence of Chronic Kidney Disease and the Incidence of Acute Kidney Injury in Patients with Coronary Artery Disease in Mumbai, India. Heart Views 2015; 16:47-52. [PMID: 26240732 PMCID: PMC4485201 DOI: 10.4103/1995-705x.159219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objective: To determine the prevalence of chronic kidney disease (CKD) and incidence of acute kidney injury (AKI) in patients with coronary artery disease (CAD) demonstrated on coronary angiography. Materials and Methods: Totally, 125 patients admitted to Lilavati Hospital and Research Centre, Mumbai, with CAD were included in the study. Results: Left anterior descending artery was the major vessel involved (40%), followed by a circumflex artery (21.6%). 49 out of 125 (39.2%) were found to have underlying CKD. 69% (34) of these CKD patients developed AKI. 21 out of 34 patients who developed AKI required hemodialysis. Only 47.1% (16 out of 34) of CKD patients had complete recovery, 29% had partial recovery, and 23% had no recovery of their renal function from AKI. Statistically significant number of patients in CKD group had no recovery from AKI as compared to non-CKD group (23.5% vs. 0%). Conclusion: Our study concludes that there is a very high prevalence of CKD (39.2%) in patients with CAD and AKI is a very important complication (38.4%) in these patients. Considering such a high prevalence of CKD, nephrology referral must be considered in patients with abnormal urinalysis, spot urinary protein to creatinine ratio and in patients whose creatinine clearance is <60 ml/min.
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Affiliation(s)
- Pavan Malleshappa
- Department of Medicine, Division of Nephrology, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Mandya, Karnataka, India
| | - Bharat V Shah
- Department of Nephrology, Global Hospital, Mumbai, Maharashtra, India
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Papaioannou A, Rigas G, Plageras P, Karikas GA, Karamanis G. Assessment and modeling of routinely used biochemical laboratory data of healthy individuals and end-stage renal failure (ESRF) patients by three different chemometric methods. J Clin Lab Anal 2013; 27:211-9. [PMID: 23686778 DOI: 10.1002/jcla.21586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, the use of biochemical markers has received increasing attention for purposes of risk assessment and clinical management in renal failure patients. Chemometric methods are often used in medical studies and there are already indications for their specific role as a tool of the medical statistics. METHODS Three chemometric methods, discriminant analysis (DA), binary logistic regression analysis (BLRA), and cluster analysis (CA), were used for assessment and modeling of routinely used biochemical laboratory data of 18 parameters that were determined from 185 healthy individuals (HIs) and 173 end-stage renal failure (ESRF) patients. RESULTS The above-mentioned chemometric methods were performed using the data set of 14 parameters since the rest 4 parameters did not present significant difference between healthy and patients. DA created a model using only ALB (Albumin), K (Potassium), TG (Triglyceride), and ALP (Alkaline phosphatase); BLRA model also used the above four parameters; CA classified all the cases into two clusters using the same four parameters and one more parameter, AST (aspartate aminotransferase). CONCLUSIONS This study provides models for assessment and modeling of routinely used biochemical laboratory data, finding groups of similarity among clinical tests usually determined on HIs and ESRF patients, contributing in data mining and reducing costs.
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Affiliation(s)
- Agelos Papaioannou
- Department of Medical Laboratories, Section of Clinical Chemistry-Biochemistry, Education & Technological Institute of Larissa, Greece.
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Fischer MJ, Ho PM, McDermott K, Lowy E, Parikh CR. Chronic kidney disease is associated with adverse outcomes among elderly patients taking clopidogrel after hospitalization for acute coronary syndrome. BMC Nephrol 2013; 14:107. [PMID: 23688069 PMCID: PMC3668174 DOI: 10.1186/1471-2369-14-107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 05/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with worse outcomes among patients with acute coronary syndrome (ACS). Less is known about the impact of CKD on longitudinal outcomes among clopidogrel treated patients following ACS. METHODS Using a retrospective cohort design, we identified patients hospitalized with ACS between 10/1/2005 and 1/10/10 at Department of Veterans Affairs (VA) facilities and who were discharged on clopidogrel. Using outpatient serum creatinine values, estimated glomerular filtration rate [eGFR (1.73 ml/min/m2)] was calculated using the CKD-EPI equation. The association between eGFR and mortality, hospitalization for acute myocardial infarction (AMI), and major bleeding were examined using Cox proportional hazards models. RESULTS Among 7413 patients hospitalized with ACS and discharged taking clopidogrel, 34.5% had eGFR 30-60 and 11.6% had eGFR < 30. During 1-year follow-up after hospital discharge, 10% of the cohort died, 18% were hospitalized for AMI, and 4% had a major bleeding event. Compared to those with eGFR > =60, individuals with eGFR 30-60 (HR 1.45; 95% CI: 1.18-1.76) and < 30 (HR 2.48; 95% CI: 1.97-3.13) had a significantly higher risk of death. A progressive increased risk of AMI hospitalization was associated with declining eGFR: HR 1.20; 95% CI: 1.04-1.37 for eGFR 30-60 and HR 1.47; 95% CI: 1.22-1.78 for eGFR < 30. eGFR < 30 was independently associated with over a 2-fold increased risk in major bleeding (HR 2.09; 95% CI: 1.40-3.12) compared with eGFR > = 60. CONCLUSION Lower levels of kidney function were associated with higher rates of death, AMI hospitalization, and major bleeding among patients taking clopidogrel after hospitalization for ACS.
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Tang CH, Chen TH, Wang CC, Hong CY, Huang KC, Sue YM. Renin-angiotensin system blockade in heart failure patients on long-term haemodialysis in Taiwan. Eur J Heart Fail 2013; 15:1194-202. [PMID: 23671265 DOI: 10.1093/eurjhf/hft082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS Heart failure is among the most frequent complications of patients on long-term haemodialysis. The benefits of renin-angiotensin system (RAS) blockade on the outcomes of these patients have yet to be determined. METHODS AND RESULTS We conducted a nationwide observational study using data from the Taiwan National Health Insurance claims database, between 1999 and 2010. We enrolled patients aged ≥35 years with new-onset heart failure [diagnosed by International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM) codes] under treatment with medications. New users of a RAS blocker (RASB; i.e., an ACE inhibitor or an ARB used as monotherapy or dual therapy) were selected to compare with non-RASB users. We used Cox proportional hazards regression with and without propensity score adjustment to compare the risk of 3-year all-cause and cardiovascular mortality. Stratified analyses and RASB therapy duration as a time-dependent covariate were also performed. In all, 4771 were treated with an RASB (n = 3024) or without an RASB (n = 1747). RASB users had a higher prevalence of hypertension and diabetes, and a higher number of hospitalization. Among RASB users, 1148 deaths (38.0%) occurred during 5272 person-years of follow-up compared with 734 deaths (42.0%) among non-RASB users during 2683 person-years of follow-up. Three-year mortality rates were 45.4% and 49.1% for patients receiving and those not receiving an RASB, respectively (log-rank test, P < 0.001). Adjusted hazard analysis revealed that RASB therapeutic effects remained significant on all-cause [hazard ratio (HR) 0.8; 95% confidence interval (CI) 0.72-0.89; P < 0.001] and cardiovascular mortality (HR 0.76; 95% CI 0.64-0.90; P < 0.01). CONCLUSIONS RASB therapy reduced all-cause and cardiovascular mortality in heart failure patients on long-term haemodialysis.
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Affiliation(s)
- Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
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19
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Diagnosis and treatment of coronary artery disease in hemodialysis patients evaluated for transplant. Transplant Res 2012; 1:3. [PMID: 23369274 PMCID: PMC3552574 DOI: 10.1186/2047-1440-1-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 04/24/2012] [Indexed: 12/28/2022] Open
Abstract
We present a review of current strategies for the diagnosis and treatment of coronary artery disease (CAD) in patients with advanced chronic kidney disease who are on the waiting list for transplants, based on data from the literature and originated from a single-center cohort of 1,250 patients with maximum follow-up of 12 years. We discuss the best way to select patients to be tested for CAD, how to choose the more adequate screening test for CAD and cardiovascular disease, how to select patients for invasive treatment studies and how to treat patients with significant CAD. We also suggest new research avenues to be explored to resolve some problems in this area.
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Kim HW, Lee JW, Je HG, Choi SH, Jo KH, Song H. On-Pump versus Off-pump Myocardial Revascularization in Patients with Renal Insufficiency: Early and Mid-term Results. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 44:323-31. [PMID: 22263182 PMCID: PMC3249334 DOI: 10.5090/kjtcs.2011.44.5.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 03/16/2011] [Accepted: 04/01/2011] [Indexed: 11/16/2022]
Abstract
Background Myocardial revascularization in patients with renal insufficiency is challenging to the cardiac surgeon, irrespective of utilizing extracorporeal circulation. This study aimed to compare the number of bypass grafts and the mid-term results and to evaluate independent survival predictors in patients with renal insufficiency undergoing on-pump or off-pump myocardial revascularization. Materials and Methods We retrospectively analyzed the data of 103 patients with renal insufficiency, who had isolated myocardial revascularization between January 1999 and January 2009. The patients were divided into two groups, the on-pump group and the off-pump group. Results The off-pump group received a significantly greater number of distal arterial grafts than the on-pump group. However, the mean number of total grafts, the degree of complete revascularization, and survival rate of the patients were not significantly different between the two groups. Multivariate analysis showed the independent predictors for reduced mid-term survival were the number of total grafts and postoperative periodic renal replacement therapy. Off-pump myocardial revascularization does not decrease the number of bypass grafts or influence on the mid-term results for patients with renal insufficiency, compared to on-pump myocardial revascularization. Conclusion Myocardial revascularization with a large number of total grafts has a beneficial effect on survival in patients with renal insufficiency, irrespective of utilizing extracorporeal bypass.
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Affiliation(s)
- Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
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Vogt A, Schoelmerich A, Pollner F, Schlitt M, Raaz U, Maegdefessel L, Reindl I, Buerke M, Werdan K, Schlitt A. Comparison of outcome in 1809 patients treated with drug-eluting stents or bare-metal stents in a real-world setting. Vasc Health Risk Manag 2011; 7:693-9. [PMID: 22174579 PMCID: PMC3237098 DOI: 10.2147/vhrm.s24370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to determine the long-term safety of drug-eluting stent (DES) versus bare metal stent (BMS) implantation in a “real-world” setting. Patients and methods A total of 1809 patients who were treated with implantation of either BMS or DES were assessed. Kaplan-Meier and multivariate Cox regression analyses concerning primary endpoint of cardiac mortality were performed. Results A total of 609 patients received DES. Mean age was 66.2 ± 11.3 years, 69.4% were male, and 1517 (83.8%) were treated for acute coronary syndrome (unstable angina 510 [28.2%], non-ST-elevation myocardial infarction [NSTEMI] 506 [28.0%], and ST-elevation myocardial infarction [STEMI] 501 [27.7%]). Mean follow-up was 34 ± 15 months. During follow-up, 268 patients died of cardiac causes (DES 42 [7.3%]; BMS 226 [19.6%]; P < 0.001). Univariate Kaplan-Meier analysis showed an advantage of DES over BMS concerning the primary end-point (P < 0.001). When adjusting for classic risk factors and additional factors that affect the progression of coronary heart disease (CHD), DES was not found to be superior to BMS (hazard ratio 0.996, 95% confidence interval 0.455–2.182, P = 0.993). Severely impaired renal function was an independent predictor for cardiac mortality after stent implantation. Conclusion Treatment with DES is safe in the long term, also in patients presenting with STEMI. However, in multivariate analyses it is not superior to BMS treatment.
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Affiliation(s)
- Alexander Vogt
- Department of Medicine III, Martin Luther-University, Halle, Germany.
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Zencirci B. Safe spinal anesthesia in a woman with chronic renal failure and placenta previa. Int J Gen Med 2010; 3:153-6. [PMID: 20689686 PMCID: PMC2915524 DOI: 10.2147/ijgm.s11421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Indexed: 12/30/2022] Open
Abstract
Background: Chronic renal failure is strongly associated with poor pregnancy outcome. Women dependent on hemodialysis before conception rarely achieve a successful live birth. Case presentation: A 31-year-old multiparous Turkish woman was scheduled for cesarean section under spinal anesthesia at 37 weeks and five days’ gestation because of hemorrhage due to secondary placenta previa. Spinal anesthesia with 8 mg of hyperbaric bupivacaine was successfully performed. Invasive blood pressure, central venous pressure, and heart rate were stable during the surgery. The mother returned to regular hemodialysis on the first postoperative day. Conclusion: Pregnancy is uncommon in women with chronic renal failure requiring chronic dialysis. Rates of maternal hypertension, pre-eclampsia, anemia, and infection in the pregnant chronic dialysis patient are high. However, our findings suggest that with careful, close, and effective monitoring preoperatively and intraoperatively, spinal anesthesia can be safely performed for cesarean section in patients undergoing hemodialysis.
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El-Menyar A, Zubaid M, Sulaiman K, Singh R, Al Thani H, Akbar M, Bulbanat B, Al-Hamdan R, AlMahmmed W, Al Suwaidi J. In-hospital major clinical outcomes in patients with chronic renal insufficiency presenting with acute coronary syndrome: data from a Registry of 8176 patients. Mayo Clin Proc 2010; 85:332-40. [PMID: 20360292 PMCID: PMC2848421 DOI: 10.4065/mcp.2009.0513] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the impact of chronic renal insufficiency (CRI) on in-hospital major adverse cardiac events across the acute coronary syndrome (ACS) spectrum. PATIENTS AND METHODS From January 29, 2007, through July 29, 2007, 6 adjacent Middle Eastern countries participated in the Gulf Registry of Acute Coronary Events, a prospective, observational registry of 8176 patients. Patients were categorized according to estimated glomerular filtration rate into 4 groups: normal (>or=90 mL/min), mild (60-89 mL/min), moderate (30-59 mL/min), and severe CRI (<30 mL/min). Patients' characteristics and in-hospital major adverse cardiac events in the 4 groups were analyzed. RESULTS Of 6518 consecutive patients with ACS, 2828 (43%) had mild CRI, 1304 (20%) had moderate CRI, and 345 (5%) had severe CRI. In CRI groups, patients were older and had a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia. On admission, these patients had a higher resting heart rate and frequently had atypical and delayed presentations. Compared with the normal estimated glomerular filtration group, CRI groups were less likely to receive antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors, and statins and were less likely to undergo coronary angiography. In-hospital heart failure, cardiogenic shock, and major bleeding episodes were significantly higher in all CRI groups. In multivariate analysis, mild, moderate, and severe CRI were associated with a higher adjusted odds ratio (OR) of death (mild: OR, 2.1; 95% confidence interval [CI], 1.2-3.7; moderate: OR, 6.7; 95% CI, 3.9-11.5; and severe: OR, 12.0; 95% CI, 6.6-21.7). CONCLUSION Across the ACS spectrum, patients with CRI had a worse risk profile, had more atypical and delayed presentations, and were less likely to receive evidence-based therapy. Chronic renal insufficiency of varying stages is an independent predictor of in-hospital morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jassim Al Suwaidi
- Individual reprints of this article are not available. Address correspondence to Jassim Al Suwaidi, MBChB, Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital (HMC), PO Box 3050, Doha, Qatar ()
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El-Menyar AA, Al Suwaidi J, Holmes DR. Use of drug-eluting stents in patients with coronary artery disease and renal insufficiency. Mayo Clin Proc 2010; 85:165-71. [PMID: 20118392 PMCID: PMC2813825 DOI: 10.4065/mcp.2009.0314] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Renal insufficiency (RI) has been shown to be associated with increased major adverse cardiovascular events after percutaneous coronary intervention. We reviewed the impact of RI on the pathogenesis of coronary artery disease and outcomes after percutaneous coronary intervention in the form of drug-eluting stent (DES) implantation in these high-risk patients. We searched the English-language literature indexed in MEDLINE, Scopus, and EBSCO Host research databases from 1990 through January 2009, using as search terms coronary revascularization, drug-eluting stent, and renal insufficiency. Studies that assessed DES implantation in patients with various degrees of RI were selected for review. Most of the available data were extracted from observational studies, and data from randomized trials formed the basis of a post hoc analysis. The outcomes after coronary revascularization were less favorable in patients with RI than in those with normal renal function. In patients with RI, DES implantation yielded better outcomes than did use of bare-metal stents. Randomized trials are needed to define optimal treatment of these high-risk patients with coronary artery disease.
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Affiliation(s)
| | | | - David R. Holmes
- Individual reprints of this article are not available. Address correspondence to David R. Holmes Jr, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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[Diagnostics and treatment of ischemic heart disease in hemodialysis patients]. VOJNOSANIT PREGL 2009; 66:897-903. [PMID: 20017421 DOI: 10.2298/vsp0911897p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Coronary flow reserve is impaired in hypertensive patients with subclinical renal damage. Am J Hypertens 2009; 22:191-6. [PMID: 19151691 DOI: 10.1038/ajh.2008.351] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Renal dysfunction is relatively common in patients with primary hypertension (PH). A reduction in coronary vasodilator capacity has recently been reported in patients with renal damage undergoing coronary angiography. We investigated the relationship between coronary flow reserve (CFR) and early renal abnormalities in patients with PH and normal serum creatinine. METHODS Seventy-six untreated patients were studied. Albuminuria was measured as the albumin-to-creatinine ratio and glomerular filtration rate (eGFR) was estimated by the Cockroft-Gault formula. Chronic kidney disease (CKD) was defined as an eGFR <60 ml/min/1.73 m(2) and/or in the presence of microalbuminuria. Coronary blood flow velocities (cm/s) were measured by Doppler ultrasound at rest and after adenosine administration. CFR was defined as the ratio of hyperemic-to-resting diastolic peak velocities. RESULTS Prevalence of reduced eGFR, microalbuminuria, CKD, and left ventricular (LV) hypertrophy was 8, 10, 16, and 31%, respectively. Overall, 10% of patients showed impaired CFR (i.e., <2.0). Patients with CKD were more likely to be older (P < 0.05) and of female gender (P < 0.01) and showed higher LV mass index (LVMI) (P < 0.05), lower CFR (P < 0.05; analysis of covariance, P < 0.05), and CFR/LVMI (P < 0.05) than patients with normal renal function. Conversely, patients with impaired CFR showed a significantly higher prevalence of reduced eGFR (chi(2) 5.2, P < 0.05), microalbuminuria (chi(2) 10.2, P < 0.01), and CKD (chi(2) 9.2.1, P < 0.01). Even after adjustment for gender, the presence of CKD entailed a sevenfold higher risk of having impaired CFR (confidence interval 1.17-40.9, P < 0.05). CONCLUSION Early renal abnormalities are associated with reduced CFR in PH.
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Cohen M. Expanding the recognition and assessment of bleeding events associated with antiplatelet therapy in primary care. Mayo Clin Proc 2009; 84:149-60. [PMID: 19181649 PMCID: PMC2664586 DOI: 10.1016/s0025-6196(11)60823-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Antiplatelet therapy is an evidence-based, guideline-recommended, worldwide standard of care for treatment of patients with atherothrombosis. However, clinical implementation of the guidelines is suboptimal, in part because of physician and patient nonadherence. The increased risk of bleeding associated with antiplatelet therapy is often the reason for nonadherence, and several programs have been created to increase adherence to guideline treatment recommendations. Despite the relative success of such initiatives, including Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines, Guidelines Applied in Practice, and the American Heart Association's Get With the Guidelines and a Science Advisory, a current estimate is that less than 50% of atherothrombotic patients are taking antiplatelet therapies as recommended by national guidelines. A PubMed and MEDLINE search of the literature (January 1, 1983-May 15, 2008) was performed to examine the bleeding risks associated with various antiplatelet therapies. Relevant clinical trials, observational registry data, and other studies relevant to treatment and guideline recommendations were selected from articles generated through specific search terms. This comprehensive review contributes to the understanding of the benefit-to-risk ratio of antiplatelet therapy for patients with atherothrombosis.
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Affiliation(s)
- Marc Cohen
- Newark Beth Israel Medical Center, Newark, NJ 07112, USA.
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Levy R, DellaValle A, Atav AS, ur Rehman A, Sklar AH, Stamato NJ. The relationship between glomerular filtration rate and survival in patients treated with an implantable cardioverter defibrillator. Clin Cardiol 2008; 31:265-9. [PMID: 18543307 DOI: 10.1002/clc.20209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES We explored the association between renal insufficiency (RI) and mortality among patients treated with an implantable cardioverter defibrillator (ICD). BACKGROUND Randomized trials have shown improvements in survival among select patients treated with an ICD. Renal insufficiency patients have a high risk of cardiac death; however, it is not clear whether the ICD has a positive effect on survival in this group of patients. METHODS This was a retrospective review of a single-center experience of 346 patients treated with an ICD. Patients were stratified into 4 groups according to their glomerular filtration rate (eGFR; expressed as mL/min/ -1.73 m(2)) at implantation: group I, > 75.0; group II, - 60.0 to 74.9; group III, - 45.0 to 59.9; and group IV, - < or = 45.0. All-cause mortality was the primary end point, with differences in survival times among the 4 groups of patients expressed in Kaplan-Meier curves. RESULTS Mean follow-up was 3.5 y (range 0.1 to 12.9 y), during which 67 patients died (19%). Mortality in each eGFR group was: I - 6.8%, II - 13.8%, III - 11.5%, IV - 45.8% (p < 0.001). Survival times (mean, y) were I, 3.74; II, 3.66; III, 3.38, and IV, 2.82. The presence of diabetes was not a factor in the outcomes. CONCLUSIONS Patients treated with an ICD with an eGFR of < or = 45.0 mL/min/1.73 m(2) have a significantly shorter survival time than those patients with an eGFR > 45.0 mL/min/1.73 m(2). Patients with an eGFR > 45.0 mL/min/1.73 m(2) appear to have equally good outcomes when treated with an ICD. This may have implications for patient selection for ICD therapy.
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Affiliation(s)
- Ronni Levy
- Columbia University, New York, New York, USA
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Bennett MR, Ravipati N, Ross G, Nguyen MT, Hirsch R, Beekman RH, Rovner L, Devarajan P. Using proteomics to identify preprocedural risk factors for contrast induced nephropathy. Proteomics Clin Appl 2008; 2:1058-1064. [PMID: 18953418 DOI: 10.1002/prca.200780141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Contrast induced nephropathy (CIN) is the third leading cause of hospital acquired acute kidney injury (AKI). We conducted a cross-sectional study in children undergoing elective cardiac catheterization to determine if there is a distinct preprocedural urinary proteomic profile in subjects who subsequently develop CIN. Of 90 patients enrolled, AKI due to CIN (defined as a 50% or greater increase in serum creatinine) occurred in 10 participants by the 24 h postcontrast time point. Seven patients who did not develop AKI served as age and gender matched controls. SELDI-TOF-MS was performed using Protein Chips with different chromatographic surfaces. A 4480 Da biomarker displayed significantly greater peat intensities on three chromatographic surfaces (p = 0.02-0.001) in control patients at time = 0 with an area under the curve (AUC) of 0.89-0.99. This biomarker was identified as the 41 amino acid (a.a.) variant of human beta-defensin-1. Another biomarker of 4631 Da was found to have a significantly greater peak intensity (p = 0.03) in AKI patients at time = 0, with an AUC of 0.84. Thus, the presence of a 4631 Da peptide, as well as the absence of the 41 a.a. variant of human beta-defensin-1 in the pre-procedural urine, may prove to be useful biomarkers for the early prediction of CIN.
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Affiliation(s)
- Michael R Bennett
- Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Guidelines for the management of acute coronary syndromes 2006. Med J Aust 2006; 184:S1-S32. [PMID: 16618231 DOI: 10.5694/j.1326-5377.2006.tb00304.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 02/20/2006] [Indexed: 11/17/2022]
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Gupta R, Uretsky BF. Gadodiamide-Based Coronary Angiography in a Patient with Severe Renal Insufficiency. J Interv Cardiol 2005; 18:379-83. [PMID: 16202115 DOI: 10.1111/j.1540-8183.2005.00073.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The risk of contrast-induced nephropathy (CIN) is extremely high in patients with preexisting renal insufficiency. Gadolinium-based coronary angiography has been proposed as an approach to prevent CIN in this high risk subgroup. We report the use of gadodiamide-based coronary angiography in a patient with severe renal insufficiency and in vitro comparisons of combinations of iodinated contrast with gadodiamide and saline.
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Affiliation(s)
- Rajiv Gupta
- From the University of Texas Medical Branch, Galveston, Texas 77555, USA
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Abstract
Several controlled interventional trials have shown the benefit of anti-hypertensive and hypolipidaemic drugs for the prevention of coronary heart disease (CHD). International guidelines for the prevention of CHD agree in their recommendations for tertiary prevention and recommend lowering the blood pressure to below 140 mm/90 mm Hg and low density lipoprotein (LDL)-cholesterol to below 2.6 mmol/l in patients with manifest CHD. Novel recommendations for secondary prevention are focused on the treatment of the pre-symptomatic high-risk patient with an estimated CHD morbidity risk of higher than 20% per 10 years or an estimated CHD mortality risk of higher than 5% per 10 years. For the calculation of this risk, the physician must record the following risk factors: sex, age, family history of premature myocardial infarction, smoking, diabetes, blood pressure, total cholesterol, LDL-cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglyceride. This information allows the absolute risk of myocardial infarction to be computed by using scores or algorithms which have been deduced from results of epidemiological studies. To improve risk prediction and to identify new targets for intervention, novel risk factors are sought. High plasma levels of C-reactive protein has been shown to improve the prognostic value of global risk estimates obtained by the combination of conventional risk factors and may influence treatment decisions in patients with intermediate global cardiovascular risk (CHD morbidity risk of 10%-20% per 10 years or CHD mortality risk of 2%-5% per 10 years).
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Affiliation(s)
- A von Eckardstein
- Institute of Clinical Chemistry, University Hospital Zurich, Switzerland.
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