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Elbadawi A, Elgendy IY, Mohamed AH, Almahmoud MF, Omer M, Abuzaid A, Mahmoud K, Ogunbayo GO, Denktas A, Paniagua D, Banerjee S, Jneid H. Temporal Trends and Outcomes of Transcatheter Mitral Valve Repair and Surgical Mitral Valve Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1560-1566. [PMID: 32620401 DOI: 10.1016/j.carrev.2020.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a paucity of data regarding the contemporary changes in the uptake and outcomes of transcatheter mitral valve repair (TMVR) and surgical mitral valve repair/replacement (SMVR). METHODS We queried the NIS database (2012-2016) to identify hospitalizations for TMVR and SMVR. We reported the temporal trends for uptake of TMVR and SMVR and their in-hospital outcomes. RESULTS The analysis included 77,645 hospitalizations: 8760 (11.3%) for TMVR and 68,885 (88.7%) for SMVR. Those undergoing TMVR were older and had a higher prevalence of comorbidities, but shorter length of stay (5.5 ± 8.8 vs. 14.3 ± 13.8, p < 0.001) compared with SMVR. There was a marked increase in the number of TMVRs over time (from 420 in 2012 to 3850 in 2016; +917%; Ptrend = 0.008) but a modest increase in the number of SMVRs (+117%; Ptrend = 0.02). Overall, TMVR was associated with low in-hospital mortality (2%) and favorable safety profile. After adjusting for clinical and hospital variables, there were non-significant trends towards lower adjusted mortality among TMVR and SMVR (Ptrend = 0.16 and Ptrend = 0.13, respectively). Notably, among TMVR patients, female sex was associated with lower in-hospital mortality while CKD was associated with increased in-hospital mortality. There was a significant downtrend in the incidences of cardiac arrest, hemodialysis and length of stay in TMVR patients. CONCLUSION Real world data showed a steady increase in the number of TMVR and SMVR procedures. Overall, TMVR was associated with low in-hospital mortality and complications rates. Despite older age and increased comorbidities, TMVR patients had lower in-hospital mortality and shorter length than their SMVR counterparts.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States of America
| | - Mohamed F Almahmoud
- Division of Cardiovascular Medicine, University of South Carolina, Charleston, SC, United States of America
| | - Mohmed Omer
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - A Abuzaid
- Division of Cardiovascular Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robins, GA, United States of America
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Ali Denktas
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX, United States of America
| | - David Paniagua
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX, United States of America
| | - Subhash Banerjee
- Division of Cardiovascular Medicine, University of Texas South Western, Dallas, TX, United States of America
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX, United States of America.
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Lee S, Koppensteiner R, Kopp CW, Gremmel T. α-Hydroxybutyrate dehydrogenase is associated with atherothrombotic events following infrainguinal angioplasty and stenting. Sci Rep 2019; 9:18200. [PMID: 31796860 PMCID: PMC6890648 DOI: 10.1038/s41598-019-54899-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Besides clinical characteristics, easy-accessible laboratory markers could be of value to refine risk stratification in peripheral artery disease. In the current study, we investigated whether α-hydroxybutyrate dehydrogenase (HBDH) is associated with atherothrombotic events in 83 stable patients undergoing infrainguinal angioplasty and stenting. The primary endpoint was defined as the composite of the first occurrence of nonfatal myocardial infarction, nonfatal stroke or transient ischemic attack and cardiovascular death within 2 years after angioplasty and stenting, and occurred in 6 patients (7.2%). HBDH levels at baseline were significantly higher in patients who subsequently developed the primary endpoint (126 U/L [116–137 U/L] vs. 105 U/L [95–120 U/L]; p = 0.04). ROC curve analysis revealed that HBDH could distinguish between patients without and with future atherothrombotic events. A HBDH concentration ≥ 115 U/L was identified as the best threshold to predict the composite endpoint, providing a sensitivity of 83.3% and a specificity of 71.4%, and was therefore defined as high HBDH. High HBDH was seen in 28 patients (33.7%). Ischemic events occurred significantly more often in patients with high HBDH than in patients with lower HBDH levels (5 vs. 1 patients, p = 0.007). In conclusion, HBDH is associated with the occurrence of atherothrombotic events after infrainguinal angioplasty with stent implantation. Future trials are warranted to study the predictive role of HBDH for ischemic outcomes and to investigate underlying mechanisms.
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Affiliation(s)
- Silvia Lee
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christoph W Kopp
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria. .,Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria.
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Abstract
PURPOSE OF REVIEW Non-ST-elevation myocardial infarction (NSTEMI) is an urgent medical condition that requires prompt application of simultaneous pharmacologic and non-pharmacologic therapies. The variation in patient clinical characteristics coupled with the multitude of treatment modalities makes optimal and timely management challenging. This review summarizes risk stratification of patients, the role and timing of revascularization, and highlights important considerations in the revascularization approach with attention to individual patient characteristics. RECENT FINDINGS The early invasive management of NSTEMI has fostered a reduction in future ischemic events. Risk calculators are helpful in determining which patients should receive early invasive management. As many patients have multivessel disease, identifying the true culprit lesion can be challenging. Special attention should be given to those at the highest risk, such as diabetics, patients with renal failure, and those with left main disease. In patients with acute coronary syndrome, the decision and mode of revascularization should carefully integrate the patient's clinical characteristics as well as the complexity of the coronary anatomy.
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Affiliation(s)
- Bennet George
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, 900 S. Limestone Street, 326 Wethington Bldg, Lexington, KY, 40536-0200, USA
| | - Naoki Misumida
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, 900 S. Limestone Street, 326 Wethington Bldg, Lexington, KY, 40536-0200, USA
| | - Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, 900 S. Limestone Street, 326 Wethington Bldg, Lexington, KY, 40536-0200, USA.
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Impact of chronic kidney disease on platelet inhibition of clopidogrel and prasugrel in Japanese patients. J Cardiol 2016; 69:752-755. [PMID: 27567173 DOI: 10.1016/j.jjcc.2016.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/15/2016] [Accepted: 07/26/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND The impact of chronic kidney disease (CKD) on the antiplatelet effect of clopidogrel and low-dose (3.75mg) prasugrel in Japanese patients is largely unknown. METHODS A total of 53 consecutive Japanese patients with stable coronary artery disease who received aspirin and clopidogrel were enrolled, and categorized by estimated glomerular filtration rate (eGFR): CKD group (n=15, eGFR<60ml/min/1.73m2) and non-CKD group (n=38, eGFR≥60ml/min/1.73m2). Clopidogrel was switched to 3.75mg prasugrel. Platelet reactivity measurement using the VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA) was performed at baseline (on clopidogrel) and day 14 (on prasugrel). RESULTS The VerifyNow P2Y12 reaction units (PRU) during clopidogrel therapy was significantly higher in the CKD group than that in the non-CKD group (185.2±51.1 PRU vs. 224.3±57.0 PRU, p=0.02), whereas, the PRU with the prasugrel therapy in the CKD group and non-CKD group were not significantly different (149.9±51.1 PRU vs. 165.3±61.8 PRU, p=0.36). The PRU was significantly lower with the prasugrel therapy compared to that with the clopidogrel therapy both in the CKD group and in the non-CKD group. CONCLUSIONS Antiplatelet effect of clopidogrel but not prasugrel is attenuated in patients with CKD. Prasugrel achieves a consistently lower platelet reactivity compared with clopidogrel regardless of the presence of mild to moderate CKD.
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McCullough PA, Verrill TA. Cardiorenal Interaction: Appropriate Treatment of Cardiovascular Risk Factors to Improve Outcomes in Chronic Kidney Disease. Postgrad Med 2015; 122:25-34. [DOI: 10.3810/pgm.2010.03.2119] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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6
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Hart A, Weir MR, Kasiske BL. Cardiovascular risk assessment in kidney transplantation. Kidney Int 2014; 87:527-34. [PMID: 25296093 DOI: 10.1038/ki.2014.335] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/14/2014] [Accepted: 05/01/2014] [Indexed: 12/28/2022]
Abstract
Cardiovascular disease (CVD) remains the most common cause of death after kidney transplantation worldwide, with the highest event rate in the early postoperative period. In an attempt to address this issue, screening for CVD prior to transplant is common, but the clinical utility of screening asymptomatic transplant candidates remains unclear. A large degree of variation exists among both transplant center practice patterns and clinical practice guidelines regarding who should be screened, and opinions are based on mixed observational data with great potential for bias. In this review, we discuss the potential risks, benefits, and evidence for screening for CVD in kidney transplant candidates, and also the next steps to better evaluate and treat asymptomatic kidney transplant candidates.
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Affiliation(s)
- Allyson Hart
- 1] Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA [2] University of Minnesota Medical School, Duluth, Minnesota, USA
| | - Matthew R Weir
- Department of Medicine, Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bertram L Kasiske
- 1] Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA [2] University of Minnesota Medical School, Duluth, Minnesota, USA
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7
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Windecker S, Stortecky S, Stefanini GG, da Costa BR, Rutjes AW, Di Nisio M, Silletta MG, Maione A, Alfonso F, Clemmensen PM, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head S, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter D, Schauerte P, Sousa Uva M, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A, Kolh P, Jüni P. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis. BMJ 2014; 348:g3859. [PMID: 24958153 PMCID: PMC4066935 DOI: 10.1136/bmj.g3859] [Citation(s) in RCA: 247] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. DESIGN Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials while maintaining randomisation. ELIGIBILITY CRITERIA FOR SELECTING STUDIES A strategy of initial medical treatment compared with revascularisation by coronary artery bypass grafting or Food and Drug Administration approved techniques for percutaneous revascularization: balloon angioplasty, bare metal stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease. DATA SOURCES Medline and Embase from 1980 to 2013 for randomised trials comparing medical treatment with revascularisation. MAIN OUTCOME MEASURE All cause mortality. RESULTS 100 trials in 93,553 patients with 262,090 patient years of follow-up were included. Coronary artery bypass grafting was associated with a survival benefit (rate ratio 0.80, 95% credibility interval 0.70 to 0.91) compared with medical treatment. New generation drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with improved survival compared with medical treatment. Coronary artery bypass grafting reduced the risk of myocardial infarction compared with medical treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a trend towards a reduced risk of myocardial infarction (0.75, 0.55 to 1.01). The risk of subsequent revascularisation was noticeably reduced by coronary artery bypass grafting (0.16, 0.13 to 0.20) followed by new generation drug eluting stents (zotarolimus (Resolute): 0.26, 0.17 to 0.40; everolimus: 0.27, 0.21 to 0.35), early generation drug eluting stents (zotarolimus (Endeavor): 0.37, 0.28 to 0.50; sirolimus: 0.29, 0.24 to 0.36; paclitaxel: 0.44, 0.35 to 0.54), and bare metal stents (0.69, 0.59 to 0.81) compared with medical treatment. CONCLUSION Among patients with stable coronary artery disease, coronary artery bypass grafting reduces the risk of death, myocardial infarction, and subsequent revascularisation compared with medical treatment. All stent based coronary revascularisation technologies reduce the need for revascularisation to a variable degree. Our results provide evidence for improved survival with new generation drug eluting stents but no other percutaneous revascularisation technology compared with medical treatment.
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An update on coronary artery disease and chronic kidney disease. Int J Nephrol 2014; 2014:767424. [PMID: 24734178 PMCID: PMC3964836 DOI: 10.1155/2014/767424] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/08/2014] [Accepted: 01/21/2014] [Indexed: 01/10/2023] Open
Abstract
Despite the improvements in diagnostic tools and medical applications, cardiovascular diseases (CVD), especially coronary artery disease (CAD), remain the most common cause of morbidity and mortality in patients with chronic kidney disease (CKD). The main factors for the heightened risk in this population, beside advanced age and a high proportion of diabetes and hypertension, are malnutrition, chronic inflammation, accelerated atherosclerosis, endothelial dysfunction, coronary artery calcification, left ventricular structural and functional abnormalities, and bone mineral disorders. Chronic kidney disease is now recognized as an independent risk factor for CAD. In community-based studies, decreased glomerular filtration rate (GFR) and proteinuria were both found to be independently associated with CAD. This paper will discuss classical and recent epidemiologic, pathophysiologic, and clinical aspects of CAD in CKD patients.
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9
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Chronic kidney disease is associated with increased platelet activation and poor response to antiplatelet therapy. Nephrol Dial Transplant 2013; 28:2116-22. [DOI: 10.1093/ndt/gft103] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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10
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Muller C, Caillard S, Jesel L, El Ghannudi S, Ohlmann P, Sauleau E, Hannedouche T, Gachet C, Moulin B, Morel O. Association of Estimated GFR With Platelet Inhibition in Patients Treated With Clopidogrel. Am J Kidney Dis 2012; 59:777-85. [DOI: 10.1053/j.ajkd.2011.12.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 12/22/2011] [Indexed: 11/11/2022]
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11
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Seddon M, Curzen N. Coronary revascularisation in chronic kidney disease. Part 1: stable coronary artery disease. J Ren Care 2010; 36 Suppl 1:106-17. [PMID: 20586906 DOI: 10.1111/j.1755-6686.2010.00156.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease, myocardial infarction and cardiovascular death. Detection and treatment of coronary artery disease in CKD patients has been hampered by the limitations of screening tests, the lack of direct evidence for therapeutic interventions in this specific population, and concerns about therapy-related adverse effects. However, these patients potentially have much to gain from conventional strategies used in the general population. This review summarises the current evidence regarding the treatment of coronary artery disease in patients with CKD, with the focus on coronary revascularisation by percutaneous coronary intervention or coronary artery bypass grafting.
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Affiliation(s)
- Mike Seddon
- Wessex Cardiac Unit, Southampton University Hospitals NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
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12
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Pilmore HL. Review article: Coronary artery stenoses: detection and revascularization in renal disease. Nephrology (Carlton) 2009; 14:537-43. [PMID: 19712254 DOI: 10.1111/j.1440-1797.2009.01171.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiovascular events are markedly elevated in those with all degrees of renal impairment compared to the general population. There are well established guidelines in the general population for the management of coronary artery disease, however, similar guidelines have not been established in the renal population. This review examines the current published work on the detection of coronary artery stenoses in addition to summarizing the outcomes of revascularization in patients with kidney disease. Testing for coronary artery disease in the renal population most commonly occurs in dialysis patients as part of their assessment for renal transplantation. While a positive myocardial stress test for the detection of significant coronary artery stenoses is associated with an increased risk of cardiac events, there is no clear information currently showing that cardiovascular testing itself reduces the rate of adverse cardiac events after transplantation. Revascularization of coronary artery stenoses is associated with higher morbidity and mortality in all groups with kidney disease than in the general population, with the exception of renal transplant recipients where the mortality is likely to be similar to that of the general population. There appears to be a benefit in coronary artery bypass surgery compared to percutaneous intervention in those on dialysis and after renal transplant. Currently, there is little data to support coronary artery intervention prior to transplantation in those with asymptomatic coronary artery disease.
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Affiliation(s)
- Helen L Pilmore
- Department of Renal Medicine, Auckland Hospital, Auckland, New Zealand.
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13
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Abstract
Chronic kidney disease (CKD) is associated with accelerated progression of cardiovascular disease, perhaps because patients with CKD have a high burden of traditional cardiovascular risk factors in addition to a range of nontraditional risk factors such as inflammation and abnormal metabolism of calcium and phosphate. Although the cardiovascular burden of CKD is well documented, potentially beneficial therapies are sometimes underused in patients with stage 3-4 CKD and are rarely studied in patients on dialysis. In this Review, we describe the epidemiology of cardiovascular disease in patients with stage 3-5 CKD (excluding kidney transplant recipients) and outline cardiovascular risk factors that are relevant in this population; we then discuss the implications of this knowledge for the optimal management of cardiovascular risk in this setting. Finally, we highlight opportunities for further research.
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Affiliation(s)
- Diana Rucker
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Celik T, Iyisoy A, Yilmaz MI, Kardesoglu E, Isik E. Another battlefield for drug-eluting coronary stents: chronic kidney disease. Int J Cardiol 2009; 133:245-6; author reply 247-8. [PMID: 18055042 DOI: 10.1016/j.ijcard.2007.08.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 08/04/2007] [Indexed: 11/28/2022]
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15
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Bonello L, De Labriolle A, Roy P, Steinberg DH, Okabe T, Pinto Slottow TL, Xue Z, Torguson R, Suddath WO, Satler LF, Kent KM, Pichard AD, Lindsay J, Waksman R. Impact of optimal medical therapy and revascularization on outcome of patients with chronic kidney disease and on dialysis who presented with acute coronary syndrome. Am J Cardiol 2008; 102:535-40. [PMID: 18721508 DOI: 10.1016/j.amjcard.2008.04.040] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 12/17/2022]
Abstract
Coronary artery disease is the main cause of death in patients with chronic kidney disease (CKD). The poor prognosis associated with acute coronary syndrome (ACS) in these patients has been related to therapeutic nihilism. This study included 2,357 patients with ACS who had percutaneous coronary intervention. According to their creatinine clearance and medical history, they were divided into 3 groups: dialysis (n = 73); CKD (n= 293); and control (n= 1,991). Rates of cardiovascular events were recorded during a 1-year follow-up period. Patients in all groups received similar contemporary therapy for ACS, including percutaneous coronary intervention and optimal medial therapy. On admission, patients with CKD and patients on dialysis more often presented with cardiogenic shock (p = 0.05 and 0.02, respectively). A graded increase in the rate of major adverse cardiovascular events at 1 year was observed with decreasing renal function (control 13%, CKD 22.9%, dialysis 45.2%, p <0.001 for all comparisons). In multivariate analysis, patients with CKD and on dialysis were significantly associated with 1-year major adverse cardiac events with adjusted hazard ratios of, respectively, 1.5 (95% confidence interval 1.1 to 2.1; p = 0.009) and 2.7 (95% confidence interval 1.7 to 4.1; p <0.001). In conclusion, despite optimal contemporary medical therapy and revascularization, the prognosis of patients with CKD and, in particular, of patients undergoing dialysis, remains poor.
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Affiliation(s)
- Laurent Bonello
- Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC, USA
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Hage FG, Smalheiser S, Zoghbi GJ, Perry GJ, Deierhoi M, Warnock D, Iskandrian AE, de Mattos AM, Aqel RA. Predictors of survival in patients with end-stage renal disease evaluated for kidney transplantation. Am J Cardiol 2007; 100:1020-5. [PMID: 17826390 DOI: 10.1016/j.amjcard.2007.04.045] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 04/06/2007] [Accepted: 04/06/2007] [Indexed: 12/17/2022]
Abstract
Cardiovascular disease is the major cause of mortality in patients with end-stage renal disease (ESRD). This study examined the all-cause mortality in 3,698 patients with ESRD evaluated for kidney transplantation at our institution from 2001 to 2004. Mean age for the cohort was 48+/-12 years, and 42% were women. Stress myocardial perfusion imaging was done in 2,207 patients (60%) and coronary angiography in 260 patients (7%). There were 622 deaths (17%) during a mean follow-up period of 30+/-15 months. The presence and severity of coronary disease on angiography was not predictive of survival. Coronary revascularization did not impact survival (p=0.6) except in patients with 3-vessel disease (p=0.05). The best predictor of death was left ventricular ejection fraction, measured by gated myocardial perfusion imaging, with 2.7% mortality increase for each 1% ejection fraction decrease. In conclusion, left ventricular ejection fraction is a strong predictor of survival in patients with ESRD awaiting renal transplantation. Strategies to improve cardiac function or earlier renal transplantation deserve further studies.
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Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
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17
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Abstract
Kidney failure and chronic kidney disease (CKD) are associated with accelerated cardiovascular disease, apparently because of a high burden of traditional vascular risk factors and possibly nontraditional risk factors such as inflammation, chronic volume overload, and abnormal calcium-phosphate metabolism. Although the burden of cardiovascular disease in CKD patients is well documented, potentially beneficial therapies appear to be underused in mild to moderate CKD and are relatively understudied in those with kidney failure. This review describes the epidemiology and pathophysiology of cardiovascular disease in CKD. We also discuss the clinical and public health implications of current knowledge and outline opportunities for further research.
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Affiliation(s)
- Marcello Tonelli
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
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18
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McMurray JJV. Chronic kidney disease in patients with cardiac disease: A review of evidence-based treatment. Kidney Int 2005; 68:1419-26. [PMID: 16164616 DOI: 10.1111/j.1523-1755.2005.00552.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- John J V McMurray
- Department of Cardiology, Western Infirmary, Glasgow, Scotland, United Kingdom.
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