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Rotablation in Patients with Advanced Renal Insufficiency through End-Stage Renal Disease: Short- and Intermediate-Term Results. J Interv Cardiol 2022; 2022:7884401. [PMID: 35350479 PMCID: PMC8930227 DOI: 10.1155/2022/7884401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. Patients with advanced renal insufficiency are at high risk of coronary artery disease (CAD) and complex lesions. Treating complex calcified lesion with rotational atherectomy (RA) in these patients might be associated with higher risks and poorer outcomes. This study was set to evaluate features and outcomes of RA in these patients. Method. Consecutive patients who received coronary RA from April 2010 to April 2018 were queried from the Cath Lab database. The procedural details, angiography, and clinical information were reviewed in detail. Results. A total of 411 patients were enrolled and divided into Group A (baseline serum creatinine <5 mg/dl, n = 338) and Group B (baseline serum creatinine ≥ 5 mg/dl through ESRD, n = 73). Most patients had high-risk features (65.7% of acute coronary syndrome (ACS), 14.1% of ischemic cardiomyopathy, and 5.1% of cardiogenic shock). Group B patients were significantly younger (66.8 ± 11.4 vs. 75.2 ± 10.7 years,
) and had more RCA and LCX but less LAD treated with RA. No difference was found in lesion location, vessel tortuosity, bifurcation lesions, chronic total occlusion, total lesion length, or total lesion numbers between the two groups. Less patients in Group B obtained completion of RA (95.9% vs 99.1%,
). There was no difference in the incidence of procedural complication or acute contrast-induced nephropathy. Group B patients had more deaths and MACE while in the hospital. The MACE and CV MACE were also higher in Group B patients at 180 days and one year, mostly due to TLR and TVR. Multivariate regression analysis showed that ACS, age, peripheral artery disease (PAD), advanced renal insufficiency, ischemic cardiomyopathy/shock, and high residual SYNTAX score were independent risk factors for in-hospital MACE, whereas ACS, advanced renal insufficiency, ischemic cardiomyopathy/shock, triple-vessel disease, and PAD independently predicted MACE at 6 months. Conclusions. Rotablation is feasible, safe, and could be carried out with very high success rate in very-high-risk patients with advanced renal dysfunction through ESRD without an increase in procedural complication.
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Matsumi J, Tobita K, Shishido K, Mizuno S, Yamanaka F, Murakami M, Tanaka Y, Takahashi S, Akasaka T, Saito S. Comparison of long-term patency after endovascular therapy for superficial femoral artery occlusive disease between patients with and without hemodialysis. Catheter Cardiovasc Interv 2015; 87:1142-8. [PMID: 26700059 DOI: 10.1002/ccd.26359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/14/2015] [Accepted: 11/22/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare long-term patency after endovascular therapy (EVT) for superficial femoral artery (SFA) occlusive disease between patients with hemodialysis (HD; HD+) and those without HD (HD-). BACKGROUND Long-term patency after EVT for SFA occlusive disease in HD+ remains unknown. METHODS EVT to SFA was successfully performed in 382 consecutive patients during 2004-2011. Cox proportional hazard model estimated the hazard ratio (HR) for the loss of primary patency (PP), secondary patency (SP), and amputation-free survival (AFS) in HD+. Binominal logistic regression analysis calculated the propensity score (PS) for covariates with a P value of <0.2 for HD as a dependent variable. HRs were adjusted for PS in multivariate analysis using the Cox proportional hazard model. RESULTS PP and SP in HD+ and HD- were 47.9 and 79.4% and 68.4 and 92.5%, respectively, 4 years after EVT. There were no procedure-related amputations or in-hospital deaths. Adjusted HRs for the loss of PP, SP, and AFS were as follows: loss of PP, adjusted HR 2.010, 95% CI 1.157-3.492, P = 0.013; loss of SP, adjusted HR 2.927, 95% CI 1.236-6.933, P = 0.015; and loss of AFS, adjusted HR 1.665, 95% CI 0.994-2.791, P = 0.053. CONCLUSIONS Although HD+ had more than double the risks for loss of PP and SP than HD-, EVT to SFA in HD+ was found to be safe with an acceptable PP and SP. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Junya Matsumi
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazuki Tobita
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Koki Shishido
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shingo Mizuno
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masato Murakami
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Saeko Takahashi
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takeshi Akasaka
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization, Laboratory and Cardiovascular R&D Center, Shonan Kamakura General Hospital, Kamakura, Japan
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König J, Möckel M, Mueller E, Bocksch W, Baid-Agrawal S, Babel N, Schindler R, Reinke P, Nickel P. Risk-stratified cardiovascular screening including angiographic and procedural outcomes of percutaneous coronary interventions in renal transplant candidates. J Transplant 2014; 2014:854397. [PMID: 25045528 PMCID: PMC4089839 DOI: 10.1155/2014/854397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/08/2014] [Accepted: 05/12/2014] [Indexed: 11/19/2022] Open
Abstract
Background. Benefits of cardiac screening in kidney transplant candidates (KTC) will be dependent on the availability of effective interventions. We retrospectively evaluated characteristics and outcome of percutaneous coronary interventions (PCI) in KTC selected for revascularization by a cardiac screening approach. Methods. In 267 patients evaluated 2003 to 2006, screening tests performed were reviewed and PCI characteristics correlated with major adverse cardiovascular events (MACE) during a follow-up of 55 months. Results. Stress tests in 154 patients showed ischemia in 28 patients (89% high risk). Of 58 patients with coronary angiography, 38 had significant stenoses and 18 cardiac interventions (6.7% of all). 29 coronary lesions in 17/18 patients were treated by PCI. Angiographic success rate was 93.1%, but procedural success rate was only 86.2%. Long lesions (P = 0.029) and diffuse disease (P = 0.043) were associated with MACE. In high risk patients, cardiac screening did not improve outcome as 21.7% of patients with versus 15.5% of patients without properly performed cardiac screening had MACE (P = 0.319). Conclusion. The moderate procedural success of PCI and poor outcome in long and diffuse coronary lesions underscore the need to define appropriate revascularization strategies in KTC, which will be a prerequisite for cardiac screening to improve outcome in these high-risk patients.
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Affiliation(s)
- Julian König
- Department of Cardiology, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
- Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Martin Möckel
- Department of Cardiology, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
- Division of Emergency Medicine, Charité Campus Virchow-Klinikum and Mitte, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Eda Mueller
- Department of Cardiology and Angiology, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Wolfgang Bocksch
- Department of Cardiology, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Seema Baid-Agrawal
- Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nina Babel
- Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Ralf Schindler
- Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Petra Reinke
- Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Campus Virchow-Klinikum, Charite-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Peter Nickel
- Department of Nephrology and Intensive Care, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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Chen YY, Wang JF, Zhang YJ, Xie SL, Nie RQ. Optimal strategy of coronary revascularization in chronic kidney disease patients: a meta-analysis. Eur J Intern Med 2013; 24:354-61. [PMID: 23602222 DOI: 10.1016/j.ejim.2013.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/15/2013] [Accepted: 03/18/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have high risks of coronary artery disease (CAD). Coronary revascularization is beneficial for long-term survival, but the optimal strategy remains still controversial. METHODS We searched studies that have compared percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for revascularization of the coronary arteries in CKD patients. Short-term (30 days or in-hospital) mortality, long-term (at least 12 months) all-cause mortality, cardiac mortality and the incidence of late myocardial infarction and recurrence of revascularization were estimated. RESULTS 28 studies with 38,740 patients were included. All were retrospective studies from 1977 to 2012. Meta-analysis showed that PCI group had lower short-term mortality (OR 0.55, 95% CI 0.41 to 0.73, P<0.01), but had higher long-term all-cause mortality (OR 1.29, 95% CI 1.23 to 1.35, P<0.01). Higher cardiac mortality (OR 1.08, 95% CI 1.01 to 1.15, P<0.05), higher incidence of late myocardial infarction (OR 1.78, 95% CI 1.65 to 1.91, P<0.01) and recurring revascularization rate (OR 2.94, 95%CI 2.15 to 4.01, P<0.01) is found amongst PCI treated patients compared to CABG group. CONCLUSIONS CKD patients with CAD received CABG had higher risk of short-term mortality but lower risks of long-term all-cause mortality, cardiac mortality and late myocardial infarction compared to PCI. This could be due to less probable repeated revascularization.
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Affiliation(s)
- Yu-Yang Chen
- Department of Cardiology, The Second Affiliated Hospital of Sun Yat-sen University, West Yanjiang Road 107, Guangzhou, Guangdong, 510120, China
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Comparison of inflammatory response after implantation of sirolimus- and paclitaxel-eluting stents in patients on hemodialysis. Heart Vessels 2012; 28:308-15. [DOI: 10.1007/s00380-012-0250-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 03/23/2012] [Indexed: 10/28/2022]
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Sawai T, Miyahara M, Nakajima H, Nakamori S, Sakai M, Tamada H, Tanigawa T, Yamada N, Nakamura M, Ito M. The impact of preprocedural hemoglobin A1c on the efficacy of sirolimus-eluting and paclitaxel-eluting stents. Cardiovasc Interv Ther 2012; 27:72-83. [PMID: 22623000 DOI: 10.1007/s12928-012-0095-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 12/21/2011] [Indexed: 11/26/2022]
Abstract
Several reports have shown contrary results regarding the efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in diabetic patients. The association between hemoglobin A1c (A1c) before coronary intervention and the midterm clinical outcomes of patients treated with these stents is unclear. The enrolled population was 415 patients with diabetes or impaired glucose tolerance (IGT) who underwent follow-up angiography after being implanted with a SES (n = 282) or PES (n = 133). The enrolled population was classified into the optimal glycemic control group (n = 213) and suboptimal glycemic control group (n = 202), and the predictors of restenosis were examined in each group. In the optimal glycemic control group, the use of PES was an independent predictor of restenosis [odds ratio (OR) 9.98, 95% confidence interval (CI) 3.08-38.9, p < 0.0001]; on the other hand, the use of SES was a positive independent predictor of restenosis prevention (OR 0.10, 95% CI 0.03-0.32, p < 0.0001). In the suboptimal glycemic control group, neither stent was predictive of restenosis. In a subanalysis, preprocedural A1c (≥7.0%) was found to be an independent predictor of restenosis in the SES group (OR 3.61, 95% CI 1.14-12.8, p = 0.03), but not the PES group. Postprocedural A1c (≥7.0%) was not an independent predictor of restenosis in either stent group. This study showed that the superiority of SES compared to PES was attenuated in the suboptimal glycemic control group. Preprocedural A1c (≥7.0%) was found to be an independent predictor of restenosis in the SES group, but not in the PES group.
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Affiliation(s)
- Toshiki Sawai
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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Vaziri ND. Potential role of recombinant erythropoietin and intravenous iron preparations in target vessel re-stenosis following coronary stint insertions in hemodialysis patients. Intern Med 2011; 50:1449-50; author reply 1447. [PMID: 21847854 DOI: 10.2169/internalmedicine.50.5173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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8
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Impact of chronic kidney disease on clinical and angiographic results following implantation of sirolimus-eluting coronary stents. Cardiovasc Interv Ther 2010; 26:18-25. [DOI: 10.1007/s12928-010-0029-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
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9
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Ichimoto E, Kobayashi Y, Iijima Y, Kuroda N, Kohno Y, Komuro I. Long-term clinical outcomes after sirolimus-eluting stent implantation in dialysis patients. Int Heart J 2010; 51:92-7. [PMID: 20379041 DOI: 10.1536/ihj.51.92] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is little information about long-term (> 1 year) outcomes after sirolimus-eluting stent (SES) implantation in dialysis patients. Percutaneous coronary intervention (PCI) using SES was performed in 63 dialysis patients with 77 lesions. A control group for comparison was composed of 45 consecutive dialysis patients with 62 lesions who received PCI using bare metal stents (BMS). Clinical follow-up duration was 21.7 +/- 8.4 months in the SES group and 32.1 +/- 9.2 months in the BMS group (P < 0.01). There was no significant difference in the in-segment restenosis rate (30% versus 40%, P = 0.20) between the 2 groups. The 3-year mortality (22.5% versus 22.2%, P = 0.75), myocardial infarction (3.8% versus 4.9%, P = 0.93), target lesion revascularization (24.7% versus 31.0%, P = 0.61), and stent thrombosis rates (3.8% versus 2.4%, P = 0.73) were not significantly different between the SES and BMS groups. Compared to BMS, SES do not improve long-term clinical outcomes in dialysis patients.
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Affiliation(s)
- Eiji Ichimoto
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Chiba, Japan
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Lin JS, Wang WJ, Lin WC, Wu XM, Chao CL. Comparison of anti-Xa activity after a single intravenous bolus of low-dose enoxaparin in patients with and without end-stage renal disease. J Int Med Res 2010; 37:1890-6. [PMID: 20146888 DOI: 10.1177/147323000903700626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study was designed to evaluate anti-Xa activity hourly during the first 3 h after a single intravenous bolus of 0.5 mg/kg enoxaparin in 30 patients with end-stage renal disease (ESRD) who underwent haemodialysis, and in 30 patients with normal or mildly reduced renal function who underwent coronary angiography for chest pain (non-ESRD group). Mean +/- SD haemodialysis time was 3.9 +/- 0.3 h in the ESRD group. Of 24 patients diagnosed with coronary artery disease in the non-ESRD group, 20 underwent percutaneous coronary intervention (PCI). A peak anti-Xa activity > 0.5 IU/ml 10 min after enoxaparin injection was obtained in 90% and 93% of the non-ESRD and ESRD patients, respectively. The percentages of patients with peak anti-Xa activity in the target range (0.5 - 1.5 IU/ml) were similar in the two groups (non-ESRD 80%, ESRD 93%). Adequate anti-Xa activity (> 0.5 IU/ml) lasted about 2 h in both groups. It is concluded that a single intravenous low-dose enoxaparin (0.5 mg/kg) bolus provides anti-Xa activity adequate for elective PCI within 2 h irrespective of whether or not the patient had ESRD.
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Affiliation(s)
- J-S Lin
- Division of Cardiology, Department of Internal Medicine, Taoyuan General Hospital, Department of Health, Executive Yuan, Taoyuan, Taiwan
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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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Takeuchi I, Moriguchi M, Imaki R, Fukaya H, Shinagawa H, Shimohama T, Tojo T, Fukuda N, Inomata T, Aoyama N, Soma K, Izumi T. Hemodialysis is an independent predictor of coronary in-stent restenosis after paclitaxel eluting stent implantation. Intern Med 2010; 49:2379-84. [PMID: 21088337 DOI: 10.2169/internalmedicine.49.3798] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE A drug eluting stent is often used for high-risk patients with complications such as diabetes mellitus (DM) and hemodialysis (HD), however the factors to predict restenosis after paclitaxel-eluting stent (PES) placement have not been reported to date. METHODS Between May 2007 and August 2009, 165 consecutive patients (231 stents) received PES in our hospital. Stent diameter and length were determined by the use of intravascular ultrasound (IVUS). All patients continued to take 2 types of anti-platelet agents (aspirin and Clopidogrel or Ticlopidine). Ninety percent of the subjects received a follow-up coronary angiogram 6 months later. RESULTS Underlying diseases were hypertension in 75%, hyperlipidemia in 78% and DM in 60% (15% on insulin), and 14% of the subjects received HD. Eighty-three percent of the patients had orally taken Statin, 85% ACE/ARB and 68% had beta blockers. Mean length and diameter of PES were 21.6 ± 7.2 mm and 2.9 ± 0.3 mm, respectively. Target lesion revascularization (TLR) rate 6 months after PES placement was 14.6% overall. In HD patients TLR was 43%, hypertension 15.0%, hyperlipemia 12.4%, DM with oral medication 12.5%, DM with insulin 12.0%, respectively. In multivariate analysis, HD was an independent risk factor for TLR (p=0.0001, OR: 6.61, 95% C.I.: 2.34-18.6). CONCLUSION HD had the greatest influence on TLR after PES even though risk factors were well controlled. It is necessary to develop new PCI techniques and stents that are useful for HD patients.
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Affiliation(s)
- Ichiro Takeuchi
- Department of Cardio-Angiology, Kitasato University School of Medicine, Sagamihara, Japan.
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13
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Resting microvascular resistance and conduit artery tone: relevance to endothelium-dependent flow-mediated dilation. ACTA ACUST UNITED AC 2008; 15:677-82. [DOI: 10.1097/hjr.0b013e32830eb6d8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Ishio N, Kobayashi Y, Takebayashi H, Iijima Y, Kanda J, Nakayama T, Kuroda N, De Gregorio J, Kouno Y, Suzuki M, Haruta S, Komuro I. Impact of Drug-Eluting Stents on Clinical and Angiographic Outcomes in Dialysis Patients. Circ J 2007; 71:1525-9. [PMID: 17895545 DOI: 10.1253/circj.71.1525] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It remains unclear whether sirolimus-eluting stents (SES) have an advantage over bare metal stents (BMS) in patients on dialysis. METHODS AND RESULTS Percutaneous coronary intervention (PCI) using SES was performed in 54 dialysis patients with 69 lesions. A control group for comparison comprised 54 consecutive dialysis patients with 58 lesions who underwent PCI using BMS. Angiographic and clinical follow-ups were scheduled at 9 months. After the procedure, minimum lumen diameter (MLD) was similar between the 2 groups. At follow-up, the SES group had a higher MLD than the BMS group (1.98+/-0.83 mm vs 1.50+/-0.78 mm, p<0.01). In-stent restenosis rate was lower in lesions treated with SES than in those with BMS (22% vs 40%, p=0.048). However, there was no significant difference between the 2 groups for in-segment restenosis (31% vs 43%, p=0.3). During follow-up, there was no significant difference in the incidence of death, myocardial infarction or target lesion revascularization (TLR) (14% vs 21%, p=0.4) between the SES and BMS groups. CONCLUSIONS In this retrospective study, SES, in comparison with BMS, reduced in-stent restenosis in patients on dialysis. However, in-segment restenosis and TLR were not statistically different between lesions treated with SES and those with BMS.
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Affiliation(s)
- Naoki Ishio
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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