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Rajnochova Bloudickova S, Janek B, Machackova K, Hruba P. Standardized risk-stratified cardiac assessment and early posttransplant cardiovascular complications in kidney transplant recipients. Front Cardiovasc Med 2024; 11:1322176. [PMID: 38327495 PMCID: PMC10847279 DOI: 10.3389/fcvm.2024.1322176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in kidney transplant recipient (KTR). There is a dearth of standardized guidelines on optimal cardiovascular evaluation of transplant candidates. Methods This single-center cohort study aims to determine the effectiveness of our standardized risk-stratified pretransplant cardiovascular screening protocol, which includes coronary angiography (CAG), in identifying advanced CVD, the proper pretransplant management of which could lead to a reduction in the incidence of major cardiac events (MACE) in the early posttransplant period. Results Out of the total 776 KTR transplanted between 2017 and 2019, CAG was performed on 541 patients (69.7%), of whom 22.4% were found to have obstructive coronary artery disease (CAD). Asymptomatic obstructive CAD was observed in 70.2% of cases. In 73.6% of cases, CAG findings resulted in myocardial revascularization. MACE occurred in 5.6% (N = 44) of the 23 KTR with pretransplant CVD and 21 without pretransplant CVD. KTR with posttransplant MACE occurrence had significantly worse kidney graft function at the first year posttransplant (p = 0.00048) and worse patient survival rates (p = 0.0063) during the 3-year follow-up period compared with KTR without MACE. After adjustment, the independent significant factors for MACE were arrhythmia (HR 2.511, p = 0.02, 95% CI 1.158-5.444), pretransplant history of acute myocardial infarction (HR 0.201, p = 0.046, 95% CI 0.042-0.970), and pretransplant myocardial revascularization (HR 0.225, p = 0.045, 95% CI 0.052-0.939). Conclusion Asymptomatic CVD is largely prevalent in KTR. Posttransplant MACE has a negative effect on grafts and patient outcomes. Further research is needed to assess the benefits of pretransplant myocardial revascularization in asymptomatic kidney transplant candidates.
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Affiliation(s)
| | - Bronislav Janek
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Karolina Machackova
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petra Hruba
- Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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2
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Lacson E, Meyer KB. Routine Monthly Blood Draws in Hemodialysis: Where Is the Evidence? Am J Kidney Dis 2020; 75:465-467. [PMID: 32008858 DOI: 10.1053/j.ajkd.2019.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Eduardo Lacson
- Tufts Medical Center & Tufts University School of Medicine, Boston, MA; Dialysis Clinic, Inc, Nashville, TN.
| | - Klemens B Meyer
- Tufts Medical Center & Tufts University School of Medicine, Boston, MA
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3
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Klein EC, Kapoor R, Lewandowski D, Mason PJ. Revascularization Strategies in Patients with Chronic Kidney Disease and Acute Coronary Syndromes. Curr Cardiol Rep 2019; 21:113. [PMID: 31471758 DOI: 10.1007/s11886-019-1213-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is a highly prevalent condition that increases the incidence and complexity of acute coronary syndrome (ACS). The purpose of this review is to summarize current evidence, uncertainties, and opportunities in the management of patients with CKD and ACS, with a focus on revascularization. RECENT FINDINGS Patients with CKD have been systematically under-represented or excluded from clinical trials in ACS. Available data, however, demonstrates that although patients with CKD and ACS benefit from revascularization, they are also less likely to receive recommended medical and revascularization therapies when compared to patients with normal kidney function. Despite the increased short-term risk of major morbidity and mortality, patients with CKD and ACS should be considered for an early invasive strategy while also trying to mitigate the risks of procedural related complications. Until evidence emerges from randomized clinical trials, the decision about revascularization strategy should involve multi-disciplinary collaboration, heart team consensus, and patient shared decision-making.
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Affiliation(s)
- Evan C Klein
- Medical College of Wisconsin, Milwaukee, WI, USA
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Antukh DE, Shchekochikhin DY, Nesterov AP, Gilarov MY. Diagnosis and treatment of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. TERAPEVT ARKH 2019; 91:137-144. [DOI: 10.26442/00403660.2019.06.000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Indexed: 11/22/2022]
Abstract
This review represents different aspects of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. We discuss difficulties in diagnosis, optimal method of coronary revascularization, timing of hemodialysis session, medical therapy, as well as epidemiology and prognosis. There are no unambiguous answers to these problems because patients with end - stage renal disease were excluded from most of the studies.
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Fujii H, Kono K, Nishi S. Characteristics of coronary artery disease in chronic kidney disease. Clin Exp Nephrol 2019; 23:725-732. [PMID: 30830548 PMCID: PMC6511359 DOI: 10.1007/s10157-019-01718-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
Patients with chronic kidney disease (CKD) commonly experience cardiovascular disease (CVD), and a major cause of death in these patients is CVD. Therefore, the prevention of CVD progression is very crucial in patients with CKD. Recently, this relationship between CKD and CVD has increasingly been examined, and a concept termed “cardiorenal syndrome” has been advocated. Coronary artery disease (CAD) and myocardial injury are crucial factors that contribute to the occurrence of CVD. The initial step CAD is endothelial dysfunction that can be detected as a decrease in the coronary flow reserve (CFR). The previous studies have reported that decreased CFR is significantly correlated to coronary events and mortality. Furthermore, CFR reduces with a decline in the kidney function. Another important presentation of CAD is coronary artery calcification. Vascular calcification is a crucial pathophysiological state, particularly in patients with CKD, and it affects the stability of coronary atherosclerotic plaque. In CKD, not only the traditional risk factors but also CKD-related non-traditional risk factors play key roles in CVD progression. Therefore, the mechanisms responsible for CVD progression are very complex; however, their clarification is crucial to improve the prognosis in patients with CKD.
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Affiliation(s)
- Hideki Fujii
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Keiji Kono
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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6
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Djohan AH. A focused review on optimal coronary revascularisation in patients with chronic kidney disease: Coronary revascularisation in kidney disease. ASIAINTERVENTION 2019; 5:32-40. [PMID: 34912972 PMCID: PMC8525713 DOI: 10.4244/aij-d-18-00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 12/04/2018] [Indexed: 04/20/2023]
Abstract
Concomitant chronic kidney disease (CKD) and coronary artery disease (CAD) is known to have poor outcomes. With a thorough literature review, we discuss the pathophysiological basis behind accelerated atherosclerosis in CKD, and the role of percutaneous coronary intervention (PCI) in these patients, focusing on drug-eluting stents, coronary artery bypass grafting, and adverse outcomes. We discuss factors contributing to poor outcomes in these patients, and the need for more work in this subgroup.
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Affiliation(s)
- Andie H. Djohan
- Department of Medicine, National University Health System, Level 10, 1E Kent Ridge Road, Singapore 119228. E-mail:
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7
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Long-term clinical outcomes after coronary artery bypass graft versus everolimus-eluting stent implantation in chronic hemodialysis patients. Coron Artery Dis 2018; 29:489-494. [DOI: 10.1097/mca.0000000000000628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
PURPOSE OF REVIEW This review article focuses on the most significant cardiovascular complications in dialysis patients [sudden cardiac death (SCD), acute coronary syndromes, heart failure, and atrial fibrillation]. RECENT FINDINGS Current and ongoing research aims to quantify the rate and pattern of significant arrhythmia in dialysis patients and to determine the predominant mechanism of SCD. Preliminary findings from these studies suggest a high rate of atrial fibrillation and that bradycardia and asystole may be more frequent than ventricular arrhythmia as a cause of sudden death. A recently published matched cohort study in dialysis patients who received a defibrillator for primary prevention showed that there was no significant difference in mortality rates between defibrillator-treated patients and propensity-matched controls. Two randomized controlled trials are currently recruiting participants and will hopefully answer the question of whether implantable or wearable cardioverter defibrillators can prevent SCD. An observational study using United States Renal Data System data demonstrated how difficult it is to keep hemodialysis patients on warfarin, as more than two-thirds discontinued the drug during the first year. The ISCHEMIA-CKD trial may provide answers about the optimal strategy for the treatment of atherosclerotic coronary disease in patients with advanced chronic kidney disease. SUMMARY The article reviews the diagnosis of acute coronary syndromes in dialysis patients, current literature on myocardial revascularization, and data on fatal and nonfatal cardiac arrhythmia. The new classification of heart failure in end-stage renal disease is reviewed. Finally, available cohort studies on warfarin for stroke prevention in dialysis patients with atrial fibrillation are reviewed.
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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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Abstract
Cardiovascular disease is a major concern for patients with end-stage renal disease (ESRD), especially those on hemodialysis. ESRD patients with coronary artery disease often do not have symptoms or present with atypical symptoms. Coronary lesions in ESRD patients are characterized by increased media thickness, infiltration and activation of macrophages, and marked calcification. Several studies showed worsened clinical outcomes after coronary revascularization, which were dependent on the severity of renal dysfunction. ESRD patients on hemodialysis have the most severe renal dysfunction; thus, the clinical outcomes are worse in these patients than in those with other types of renal dysfunction. Medications for primary or secondary cardiovascular prevention are also insufficient in ESRD patients. Efficacy of drug-eluting stents is inferior in ESRD patients, compared to the excellent outcomes observed in patients with normal renal function. Unsatisfactory outcomes with trials targeting cardiovascular disease in patients with ESRD emphasize a large potential to improve outcomes. Thus, optimal strategies for diagnosis, prevention, and management of cardiovascular disease should be modified in ESRD patients.
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Affiliation(s)
- Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yuji Ikari
- Department of Cardiovascular Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Shroff GR, Herzog CA. Coronary Revascularization in Patients with CKD Stage 5D: Pragmatic Considerations. J Am Soc Nephrol 2016; 27:3521-3529. [PMID: 27493258 DOI: 10.1681/asn.2016030345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Coronary revascularization decisions for patients with CKD stage 5D present a dilemma for clinicians because of high baseline risks of mortality and future cardiovascular events. This population differs from the general population regarding characteristics of coronary plaque composition and behavior, accuracy of noninvasive testing, and response to surgical and percutaneous revascularization, such that findings from the general population cannot be automatically extrapolated. However, this high-risk population has been excluded from all randomized trials evaluating outcomes of revascularization. Observational studies have attempted to address long-term outcomes after surgical versus percutaneous revascularization strategies, but inherent selection bias may limit accuracy. Compared with percutaneous strategies, surgical revascularization seems to have long-term survival benefit on the basis of observational data but associates with substantially higher short-term mortality rates. Percutaneous revascularization with drug-eluting and bare metal stents associates with a high risk of in-stent restenosis and need for future revascularization, perhaps contributing to the higher long-term mortality hazard. Off-pump coronary bypass surgery and the newest generation of drug-eluting stent platforms offer no definitive benefits. In this review, we address the nuances, complexities, and tradeoffs that clinicians face in determining the optimal method of coronary revascularization for this high-risk population.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and .,Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
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12
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Coronary Artery Disease Assessment and Intervention in Renal Transplant Patients. Transplantation 2016; 100:1580-7. [DOI: 10.1097/tp.0000000000001157] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krishnaswami A, Goh AC, Go AS, Lundstrom RJ, Zaroff J, Jang JJ, Allen E. Effectiveness of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease. Am J Cardiol 2016; 117:1596-1603. [PMID: 27013385 DOI: 10.1016/j.amjcard.2016.02.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/19/2016] [Accepted: 02/19/2016] [Indexed: 01/24/2023]
Abstract
The optimal coronary revascularization strategy (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]) in patients with end-stage renal disease (ESRD) remains uncertain. We performed an updated systematic review and meta-analysis of observational studies comparing CABG and PCI in patients with ESRD using a random-effects model for the primary outcome of long-term all-cause mortality. Our review registered through PROSPERO included observational studies published after 2011 to ensure overlap with previous studies and identified 7 new studies for a total of 23. We found that the median sample size in the selected studies was 125 patients (25 to 15,784) with a large variation in the covariate risk adjustment and only 3 studies reporting the indications for the revascularization strategy. CABG was associated with a small reduction in mortality (relative risk 0.92, 95% CI 0.89 to 0.96) with significant heterogeneity demonstrated (p = 0.005, I(2) = 48.6%). Subgroup analysis by categorized "year of study initiation" (<1990, 1991 to 2003, >2004) further confirmed the summary estimate trending toward survival benefit of CABG along with a substantial decrease in heterogeneity after 2004 (p = 0.64, I(2) = 0%). In conclusion, our updated systematic review and meta-analysis demonstrated that in patients with ESRD referred for coronary revascularization, CABG was associated with a small decrease in the relative risk of long-term mortality compared with PCI. The generalizability of the finding to all patients with ESRD referred for coronary revascularization is limited because of a lack of known indications for coronary revascularization, substantial variation in covariate risk adjustment, and lack of randomized clinical trial data.
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14
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Di Lullo L, Rivera R, Barbera V, Bellasi A, Cozzolino M, Russo D, De Pascalis A, Banerjee D, Floccari F, Ronco C. Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies. Int J Cardiol 2016; 217:16-27. [PMID: 27174593 DOI: 10.1016/j.ijcard.2016.04.170] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) patients demonstrate higher rates of cardiovascular mortality and morbidity; and increased incidence of sudden cardiac death (SCD) with declining kidney failure. Coronary artery disease (CAD) associated risk factors are the major determinants of SCD in the general population. However, current evidence suggests that in CKD patients, traditional cardiovascular risk factors may play a lesser role. Complex relationships between CKD-specific risk factors, structural heart disease, and ventricular arrhythmias (VA) contribute to the high risk of SCD. In dialysis patients, the occurrence of VA and SCD could be exacerbated by electrolyte shifts, divalent ion abnormalities, sympathetic overactivity, inflammation and iron toxicity. As outcomes in CKD patients after cardiac arrest are poor, primary and secondary prevention of SCD and cardiac arrest could reduce cardiovascular mortality in patients with CKD.
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Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy.
| | - R Rivera
- Division of Nephrology, S. Gerardo Hospital, Monza, Italy
| | - V Barbera
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy
| | - A Bellasi
- Department of Nephrology and Dialysis, S. Anna Hospital, Como, Italy
| | - M Cozzolino
- Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Italy
| | - D Russo
- Division of Nephrology, University of Naples "Federico II", Naples, Italy
| | - A De Pascalis
- Department of Nephrology and Dialysis, Vito Fazzi Hospital, Lecce, Italy
| | - D Banerjee
- Consultant Nephrologist and Reader, Clinical Sub Dean, Renal and Transplantation Unit, St George's University, London, UK
| | - F Floccari
- Department of Nephrology and Dialysis, S. Paolo Hospital, Civitavecchia, Italy
| | - C Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
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Fujii H, Nishi S. [Singularity of coronary artery disease in chronic kidney disease.]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2016; 105:818-824. [PMID: 29182833 DOI: 10.2169/naika.105.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Chan W, Ivanov J, Ko D, Fremes S, Rao V, Jolly S, Cantor WJ, Lavi S, Overgaard CB, Ruel M, Tu JV, Džavík V. Clinical outcomes of treatment by percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with chronic kidney disease undergoing index revascularization in Ontario. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.001973. [PMID: 25582144 DOI: 10.1161/circinterventions.114.001973] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a paucity of data on the comparative effectiveness of percutaneous coronary intervention using contemporary drug-eluting stent (DES) compared with coronary artery bypass graft (CABG) surgery in patients with chronic kidney disease. METHODS AND RESULTS A population-based study was performed using the Cardiac Care Network, a provincial registry of all patients undergoing cardiac catheterization in Ontario, to evaluate patients treated with either percutaneous coronary intervention using DES or CABG between October 1, 2008, and September 30, 2011. Chronic kidney disease was defined as creatinine clearance <60 mL/min. A total of 1786 propensity-matched patients from 4006 patients with chronic kidney disease undergoing index revascularization for multivessel disease with either DES or isolated CABG (n=893 each group) were analyzed. Baseline and procedural characteristics between percutaneous coronary intervention and CABG groups were well-balanced, including urgent revascularization priority, diabetes mellitus, left ventricular function, and 3-vessel disease. The 1-, 2-, and 3-year Kaplan-Meier survival analyses in propensity-matched patients favored CABG (93.2% versus 89.3%; 86.6% versus 80.3%; 80.8% versus 71.5%, respectively; P<0.001). The CABG cohort had greater 1-, 2-, and 3-year freedom from major adverse cardiac and cerebrovascular events (89.4% versus 71.2%; 81.9% versus 60.5%; 75.2% versus 51.8%, respectively; P<0.001). Cox regression analysis identified DES use to be associated with greater hazard for late mortality (hazard ratio, 1.58; 95% confidence interval, 1.32-1.90) and major adverse cardiac and cerebrovascular events (2.62; 2.28-3.01; all P<0.001). CONCLUSIONS In this large provincial registry, CABG was associated with improved early and late clinical outcomes when compared with percutaneous coronary intervention using DES in patients with chronic kidney disease undergoing index revascularization.
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Affiliation(s)
- William Chan
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Joan Ivanov
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Dennis Ko
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Stephen Fremes
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Vivek Rao
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Sanjit Jolly
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Warren J Cantor
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Shahar Lavi
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Christopher B Overgaard
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Marc Ruel
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Jack V Tu
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.)
| | - Vladimír Džavík
- From the Department of Medicine (W.C., J.I., C.B.O., V.D.), and Department of Surgery (V.R.), Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada (J.I., D.K., J.V.T.); Department of Medicine (D.K., J.V.T.), and Department of Surgery (S.F.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Ontario, Canada (S.J.); Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada (W.J.C.); Department of Medicine, London Health Sciences Centre, London, Ontario, Canada (S.L.); and Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (M.R.).
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17
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Prognostic value of cardiac tests in potential kidney transplant recipients: a systematic review. Transplantation 2015; 99:731-45. [PMID: 25769066 DOI: 10.1097/tp.0000000000000611] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Whether abnormal myocardial perfusion scintigraphy (MPS), dobutamine stress echocardiography (DSE) or coronary angiography, performed during preoperative evaluation for potential kidney transplant recipients, predicts future cardiovascular morbidity is unclear. We assessed test performance for predicting all-cause mortality, cardiovascular mortality and major adverse cardiac events (MACE). METHODS We searched MEDLINE and EMBASE (to February 2014), appraised studies, and calculated risk differences and relative risk ratios (RRR) with 95% confidence intervals (95% CI) using random effects meta-analysis. RESULTS Fifty-two studies (7401 participants) contributed data to the meta-analysis. Among the different tests, similar numbers of patients experienced MACE after an abnormal test result compared with a normal result (risk difference: MPS 20 per 100 patients tested [95% CI, 0.11-0.29], DSE 24 [95% CI, 0.10-0.38], and coronary angiography 20 [95% CI, 0.08-0.32; P = 0.91]). Although there was some evidence that coronary angiography was better at predicting all-cause mortality than MPS (RRR, 0.69; 95% CI, 0.49-0.96; P = 0.03) and DSE (RRR, 0.72; 95% CI, 0.50-1.02; P = 0.06), noninvasive tests were as good as coronary angiography at predicting cardiovascular mortality (RRR, MPS, 0.89; 95% CI, 0.38-2.10; P = 0.78; DSE, 1.09; 95% CI, 0.12-10.05; P = 0.93), and MACE (RRR: MPS, 1.09; 95% CI, 0.64-1.86; P = 0.74; DSE, 1.56; 95% CI, 0.71-3.45; P = 0.25). CONCLUSIONS Noninvasive tests are as good as coronary angiography at predicting future adverse cardiovascular events in advanced chronic kidney disease. However, a substantial number of people with negative test results go on to experience adverse cardiac events.
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18
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Coronary artery bypass grafting and percutaneous coronary intervention in patients with end-stage renal disease. Eur J Cardiothorac Surg 2015; 47:e193-8. [DOI: 10.1093/ejcts/ezv104] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Shroff GR, Solid CA, Herzog CA. Impact of acute coronary syndromes on survival of dialysis patients following surgical or percutaneous coronary revascularization in the United States. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:205-13. [DOI: 10.1177/2048872615574106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 02/01/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, USA
| | - Craig A Solid
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, USA
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, USA
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, USA
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20
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How to balance risks and benefits in the management of CKD patients with coronary artery disease. J Nephrol 2015; 28:403-13. [PMID: 25712237 DOI: 10.1007/s40620-015-0184-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD), which remains the most common cause of morbidity and mortality in CKD patients. Although the management of CAD is more challenging in patients with CKD than in the general population, and coupled with concerns about further deterioration of renal function and therapy-related toxic effects, CKD patients and those receiving dialysis have not traditionally been included in randomized trials evaluating either medical or revascularization therapies. Thus, only scant data from small prospective studies or retrospective analyses of controlled trials and registries are available, and to date no optimal treatment approach has been defined for this subgroup of patients. However, they potentially have much to gain from the pharmacological, interventional, and surgical strategies used in the general population. Thus, the objective of this review is to summarize the current evidence regarding the management of CAD in CKD patients, in particular with respect to uncertainties regarding coronary revascularization options, and their risk-benefit relationship in such a high-risk population.
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21
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Wiernek SL, Kiesz RS, Wiernek BK, Buszman PP, Janas A, Martin JL, Trela B, Szewc RG, Buszman PE. Treatment of symptomatic coronary artery disease in patients with end-stage renal disease on hemodialysis with paclitaxel-eluting TAXUS stent. Hemodial Int 2015; 19:402-11. [PMID: 25560380 DOI: 10.1111/hdi.12259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Percutaneous coronary intervention (PCI) utilizing drug-eluting stents is becoming a very common revascularization technique in the dialysis cohort; therefore, we sought to identify the impact of dialysis on outcomes in this group of patients. This is a multicenter registry comparing results of 290 patients (186 with normal kidney function, 104 on dialysis) who underwent PCI with exclusive use of paclitaxel-eluting TAXUS stent. The primary endpoint was an assessment of major adverse cardiac events (MACE) at 1- and 2-year observation. Mean follow-up was 23.3 ± 6.1 months. Results at 12 months showed: MACE 11.8% vs. 7.7% (P = not significant [ns]), composite major adverse cardiac and cerebrovascular events (MACCE) 12.4% vs. 11.5% (P = ns), all-cause death 2.7% vs. 8.6% (P < 0.05), cardiac death 2.7% vs. 1.9% (P = ns), target vessel revascularization (TVR) 9.1% vs. 6.7% (P = ns), acute myocardial infarction (AMI) 3.8% vs. 2.9% (P = ns), cerebrovascular events (CVA) 0.5% vs. 1.0% (P = ns); and results at 24 months showed: MACE 17.7% vs. 18.3% (P = ns), MACCE 21.5% vs. 26.0% (P = ns), all-cause death 4.3% vs. 14.4% (P < 0.01), cardiac death 3.2% vs. 1.9% (P = ns), TVR 14.0% vs. 16.3% (P = ns), AMI 5.4% vs. 5.8% (P = ns), CVA 3.2% vs. 2.9% (P = ns) for non-end-stage renal disease (ESRD) and dialysis group, respectively. Prior coronary artery bypass graft (CABG) was found to be single risk factor for MACE, TVR, and MACCE in patients with ESRD, while dialysis and prior CABG were found to be single risk factors for death in the entire population. PCI with TAXUS is a feasible procedure and presents promising results in dialysis-dependent patients.
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Affiliation(s)
- Szymon L Wiernek
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,Norwalk Hospital, Yale School of Medicine, Norwalk, Connecticut, USA
| | - R Stefan Kiesz
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,University of Texas Health Science Center, San Antonio, Texas, USA
| | - Barbara K Wiernek
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,Medical University of Silesia, Katowice, Poland
| | - Piotr P Buszman
- American Heart of Poland, Katowice, Poland.,Medical University of Silesia, Zabrze, Poland
| | - Adam Janas
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,American Heart of Poland, Katowice, Poland
| | - Jack L Martin
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Robert G Szewc
- University of Texas Health Science Center, San Antonio, Texas, USA.,Kidney Specialists, San Antonio, Texas, USA
| | - Pawel E Buszman
- Medical University of Silesia, Katowice, Poland.,American Heart of Poland, Katowice, Poland
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22
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Roberts JK, McCullough PA. The management of acute coronary syndromes in patients with chronic kidney disease. Adv Chronic Kidney Dis 2014; 21:472-9. [PMID: 25443572 DOI: 10.1053/j.ackd.2014.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/13/2014] [Accepted: 08/25/2014] [Indexed: 11/11/2022]
Abstract
Coronary heart disease is highly prevalent in patients with CKD, and survival after acute coronary syndrome (ACS) is worse compared with the general population. Many trials that define guidelines for cardiovascular disease excluded patients with kidney disease, leaving a gap between the evidence base and clinical reality. The underlying pathophysiology of vascular disease appears to be different in the setting of CKD. Patients with CKD are more likely to present with myocardial infarction and less likely to be diagnosed with ACS on admission compared with the general population. Patients with CKD appear to benefit with angiography and revascularization compared with medical management alone. However, the increased risk of in-hospital bleeding and risk of contrast-induced acute kidney injury are 2 factors that can limit overall benefit for some. Thus, judicious application of available therapies for the management of ACS is warranted to extend survival and reduce hospitalizations in this high-risk population. In this review, we highlight the clinical challenges and potential solutions for managing ACS in patients with CKD.
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23
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Ren X, Liu W, Peng Y, Li Q, Chai H, Zhao ZG, Meng QT, Chen C, Zhang C, Luo XL, Chen M, Huang DJ. Percutaneous coronary intervention compared with coronary artery bypass graft in coronary artery disease patients with chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2014; 36:1177-86. [PMID: 24986458 DOI: 10.3109/0886022x.2014.934178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Xin Ren
- Department of Cardiology, West China Hospital, Sichuan University , Chengdu , China
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24
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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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25
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Tani S, Nagao K, Hirayama A. What is the appropriate strategy for coronary revascularization in hemodialysis patient in Japan? Circ J 2014; 78:841-3. [PMID: 24562635 DOI: 10.1253/circj.cj-14-0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shigemasa Tani
- Department of Cardiology, Surugadai Nihon University Hospital
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26
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Chou CL, Hsieh TC, Wang CH, Hung TH, Lai YH, Chen YY, Lin YL, Kuo CH, Wu YJ, Fang TC. Long-term Outcomes of Dialysis Patients After Coronary Revascularization: A Population-based Cohort Study in Taiwan. Arch Med Res 2014; 45:188-94. [DOI: 10.1016/j.arcmed.2014.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/27/2014] [Indexed: 11/27/2022]
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27
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Sugumar H, Lancefield TF, Andrianopoulos N, Duffy SJ, Ajani AE, Freeman M, Buxton B, Brennan AL, Yan BP, Dinh DT, Smith JA, Charter K, Farouque O, Reid CM, Clark DJ. Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention. Int J Cardiol 2014; 172:442-9. [PMID: 24521692 DOI: 10.1016/j.ijcard.2014.01.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/11/2014] [Accepted: 01/19/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Comorbidities, such as diabetes, affect revascularization strategy for coronary disease. We sought to determine if the degree of renal impairment affected long-term mortality after percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) in patients with multi-vessel coronary disease (MVD). METHODS AND RESULTS 8970 patients with MVD undergoing revascularization between 2004 and 2008, in two multi-center parallel PCI and CABG Australian registries were assigned to three groups based on their estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m2 (n=1678:839), 30-59 mL/min/1.73 m2 (n=452:226) and <30 mL/min/1.73 m2 (n=74:37). We used 2:1 propensity matching to compare 3306 patients undergoing primary CABG versus PCI. Shock, myocardial infarction (MI)<24 h, previous CABG, valve surgery or PCI were exclusions. Long-term mortality (mean 3.1 years) was compared with Cox-proportional hazard-adjusted modeling. Observed long-term mortality rates (CABG vs. PCI) were 4.5% vs. 4.3% p=0.84, 12.8% vs. 17.3% p=0.12, and 23.0% vs. 40.5% p=0.05 in the three strata, respectively. In patients with eGFR≥60 mL/min/1.73 m2, long-term mortality between PCI and CABG (HR 0.99, 95% CI 0.65-1.49, p=0.95) was similar. However, amongst patients with eGFR 30-59 mL/min/1.73 m2, there was a significant mortality hazard with PCI (HR 2.00, 95% CI 1.32-3.04, p=0.001). In patients with eGFR<30 mL/min/1.73 m2, there was a trend for hazard with PCI (HR 1.66, 95% CI 0.80-3.46, p=0.17). CONCLUSION Long-term mortality in MVD patients with preserved renal function was very low and similar between PCI and CABG. However there was a long-term mortality hazard associated with PCI amongst patients with moderate renal impairment.
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Affiliation(s)
- Hariharan Sugumar
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | | | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Brian Buxton
- Department of Cardiac Surgery, Austin Hospital, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bryan P Yan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong; Department of Cardiology, Prince of Wales Hospital, Hong Kong, China
| | - Diem T Dinh
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Julian A Smith
- Department of Surgery, Monash University, Melbourne, Victoria, Australia; Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Kerrie Charter
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David J Clark
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
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28
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Kumada Y, Ishii H, Aoyama T, Kamoi D, Kawamura Y, Sakakibara T, Nogaki H, Takahashi H, Murohara T. Long-Term Clinical Outcome After Surgical or Percutaneous Coronary Revascularization in Hemodialysis Patients. Circ J 2014; 78:986-92. [DOI: 10.1253/circj.cj-13-1357] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshitaka Kumada
- Department of Cardiovascular Surgery, Matsunami General Hospital
- Cardiovascular Center, Nagoya Kyoritsu Hospital
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toru Aoyama
- Cardiovascular Center, Nagoya Kyoritsu Hospital
| | | | | | | | - Haruhiko Nogaki
- Department of Cardiovascular Surgery, Matsunami General Hospital
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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29
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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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30
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Coronary artery disease in dialysis patients: What is the optimal therapy? Tzu Chi Med J 2013. [DOI: 10.1016/j.tcmj.2013.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Shroff GR, Solid CA, Herzog CA. Long-term survival and repeat coronary revascularization in dialysis patients after surgical and percutaneous coronary revascularization with drug-eluting and bare metal stents in the United States. Circulation 2013; 127:1861-9. [PMID: 23572500 DOI: 10.1161/circulationaha.112.001264] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few published data describe long-term survival of dialysis patients undergoing surgical versus percutaneous coronary revascularization in the era of drug-eluting stents (DES). METHODS AND RESULTS Using United States Renal Data System data, we identified 23 033 dialysis patients who underwent coronary revascularization (6178 coronary artery bypass grafting, 5011 bare metal stents, 11 844 DES) from 2004 to 2009. Revascularization procedures decreased from 4347 in 2004 to 3344 in 2009. DES use decreased by 41% and bare metal stent use increased by 85% from 2006 to 2007. Long-term survival was estimated by the Kaplan-Meier method, and independent predictors of mortality were examined in a comorbidity-adjusted Cox model. In-hospital mortality for coronary artery bypass grafting patients was 8.2%; all-cause survival at 1, 2, and 5 years was 70%, 57%, and 28%, respectively. In-hospital mortality for DES patients was 2.7%; 1-, 2-, and 5-year survival was 71%, 53%, and 24%, respectively. Independent predictors of mortality were similar in both cohorts: age >65 years, white race, dialysis duration, peritoneal dialysis, and congestive heart failure, but not diabetes mellitus. Survival was significantly higher for coronary artery bypass grafting patients who received internal mammary grafts (hazard ratio, 0.83; P<0.0001). The probability of repeat revascularization accounting for the competing risk of death was 18% with bare metal stents, 19% with DES, and 6% with coronary artery bypass grafting at 1 year. CONCLUSIONS Among dialysis patients undergoing coronary revascularization, in-hospital mortality was higher after coronary artery bypass grafting, but long-term survival was superior with internal mammary grafts. In-hospital mortality was lower for DES patients, but the probability of repeat revascularization was higher and comparable to that in patients receiving a bare metal stent. Revascularization decisions for dialysis patients should be individualized.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
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32
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Predictors for Early and Late Outcomes After Coronary Artery Bypass Grafting in Hemodialysis Patients. Ann Thorac Surg 2012; 94:1940-5. [DOI: 10.1016/j.athoracsur.2012.07.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/09/2012] [Accepted: 07/12/2012] [Indexed: 11/18/2022]
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Yeates A, Hawley C, Mundy J, Pinto N, Haluska B, Shah P. Treatment outcomes for ischemic heart disease in dialysis-dependent patients. Asian Cardiovasc Thorac Ann 2012; 20:281-91. [DOI: 10.1177/0218492312437383] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare outcomes following intervention in dialysis-dependent patients with ischemic heart disease. Background: Ischemic heart disease is a major cause of mortality in dialysis-dependent patients. Coronary revascularization and medical modification to relieve symptoms is common, however, there is no clear consensus regarding optimal treatment. Method: Ninety dialysis-dependent patients with ischemic heart disease were prospectively assessed between 1999 and 2009, with a median follow-up of 24 months; 35 received best medical management, 31 had percutaneous coronary angioplasty and stenting, and 24 had coronary artery bypass grafting. Results: By multivariate analysis, higher body mass index and lower logistic EuroSCORE were associated with having either procedure compared to medical management. Using the time-to-event Kaplan-Meier method, both stenting and coronary bypass grafting had lower risks of an adverse outcome than best medical management. Mortality was 40/90 (44.4%). Multivariate predictors of mortality were smoking and a logistic EuroSCORE of 7–14. Overall mortality was not different among groups, however, the stent group had a survival advantage at 30-days and 1-year compared to the coronary bypass group. Composite median survival was 52.3 months. SF-36 questionnaires showed quality of life after bypass grafting was significantly better than medical management or stenting. Physical function was better after bypass grafting compared to medical management or stenting. Conclusion: Dialysis-dependent patients with ischemic heart disease have poor survival despite intervention. Coronary artery bypass achieves fewer composite adverse events and better quality of life than stenting. Symptoms and coronary anatomy should dictate treatment decisions in dialysis-dependent patients.
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Affiliation(s)
- Alexander Yeates
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Carmel Hawley
- Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Julie Mundy
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Nigel Pinto
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Brian Haluska
- Department of Medicine, University of Queensland, Brisbane, Australia
| | - Pallav Shah
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Australia
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Abstract
Despite a substantial number of patients with end-stage renal disease who have coronary artery disease, the comparative effectiveness of revascularization procedures such as coronary artery bypass grafting and percutaneous coronary intervention remain unclear. Innovations in the field of coronary artery revascularization and concomitant changes in the standard of practice have improved outcomes in general. However, meaningful clinical decision-making remains difficult because it requires clinicians to extrapolate evidence derived from studies in the general population to patients with kidney disease for whom there is limited information from intervention trials. In non-randomized studies, this high-risk population for cardiovascular morbidity and mortality appear to derive substantial benefits from coronary revascularization. However, specific treatment decisions are often made based upon individual circumstances and contexts that are not well captured in these studies. This article reviews the available evidence, and its limitations, for deciding between various revascularization strategies for patients with end-stage renal disease. Several considerations that arise while making such decisions are discussed.
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Affiliation(s)
- John K Roberts
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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35
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Petrillo G, Cirillo P, Prastaro M, D'Ascoli GL, Piscione F. Percutaneous approach to treatment of coronary disease in a patient with uremic cardiomyopathy. World J Cardiol 2011; 3:117-20. [PMID: 21526049 PMCID: PMC3082735 DOI: 10.4330/wjc.v3.i4.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 04/04/2011] [Accepted: 04/11/2011] [Indexed: 02/06/2023] Open
Abstract
Uremic cardiomyopathy is chronic ischemic left ventricular dysfunction characterized by heart failure, myocardial ischemia, hypotension in dialysis and arrhythmia. This nosologic entity represents a leading cause of morbidity and mortality among patients with end-stage renal disease receiving long-term hemodialysis. It is intuitive that revascularization in the presence of coronary artery disease in these patients represents an effective option for improving their prognosis. Although the surgical option seems to be followed by the best clinical outcome, some patients refuse this option and others are not good candidates for surgery. The present report describes the case of a patient affected by uremic cardiomyopathy and severe coronary artery disease in whom revascularization with percutaneous coronary angioplasty was followed by a significant improvement in quality of life.
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Affiliation(s)
- Gianluca Petrillo
- Gianluca Petrillo, Plinio Cirillo, Maria Prastaro, Greta Luana D'Ascoli, Federico Piscione, Department of Internal Medicine, Cardiovascular and Immunological Sciences, University of Naples "Federico II" via Sergio Pansini, 5, 80131, Naples, Italy
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36
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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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37
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Butman SM. It's not the dye, but the "die" in dialysis: which coronary revascularization strategy really is best? Catheter Cardiovasc Interv 2010; 76:949-50. [PMID: 21108371 DOI: 10.1002/ccd.22892] [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]
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38
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Miller LM, Sood MM, Sood AR, Reslerova M, Komenda P, Rigatto C, Bueti J. Cardiovascular disease in end-stage renal disease: the challenge of assessing and managing cardiac disease in dialysis patients. Int Urol Nephrol 2010; 42:1007-14. [PMID: 20960231 DOI: 10.1007/s11255-010-9857-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 09/23/2010] [Indexed: 11/25/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in end-stage renal disease (ESRD), approximating a 10- to 20-fold higher risk of death in dialysis patients than in the general population. Despite this, dialysis patients often undergo fewer investigations, receive less invasive procedures, and are prescribed fewer medications compared with age-matched non-ESRD patients. A lack of randomized control trials for evidence-based treatment strategies in this population may explain some of these discrepancies, but there is concern that an attitude of "therapeutic nihilism" may be impacting on the medical care of these patients. In this review, we will explore CVD in the ESRD population. Specifically, we will try to address the following issues in patients with ESRD: (1) mechanisms of CVD, (2) cardiac evaluation and the role of coronary revascularization with percutaneous or coronary artery bypass procedures, and (3) cardiac pharmacotherapy use.
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Affiliation(s)
- Lisa M Miller
- Department of Medicine, Health Sciences Centre, GE-441, 820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada.
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