atients with end-stage renal disease (ESRD) on hemodialysis (HD) are at high risk of death from ischemic heart disease. 1-3 Furthermore, percutaneous coronary intervention (PCI) in such patients is sometimes difficult because they have more complex lesions, including massive calcification of coronary lesions and/or multivessel disease than non-HD patients. 4 Published reports have indicated that using new devices such as stents or debulking devices is associated with better outcomes after PCI in HD patients. 5,6 However, the restenosis rate in the follow-up period is higher in HD patients than in non-HD patients, although the initial success rate of PCI is similarly high in both groups. 7-10 Therefore, higher rates of restenosis remain a clinical limitation of cardiac interventions in HD patients.Recently it was reported that sirolimus-eluting stents (SES) significantly reduce the risk of restenosis after PCI in many cases, [11][12][13][14][15] and the remarkable safety and efficacy of SES has been documented not only by angiography but by intravascular ultrasound (IVUS) as well. 16,17 Moreover, even in patients with high-risk factors for coronary restenosis, including diabetes, small diameter vessels, chronic total occlusion and so on, clinical improvement has been observed. [18][19][20][21] Accordingly, in the present study we aimed to determine the efficacy of SES in patients on maintenance HD. Methods Study PopulationFrom August 2004, SES have been available in our institution, so between August 2004 and July 2005 we attempted to implant SES for all patients who needed PCI if they had no contraindications, such as acute coronary syndrome, intolerance of both of aspirin and ticlopidine, planned surgery and so on. In total, 225 consecutive Japanese patients with 322 lesions treated with SES (Cypher™) for native coronary lesions during that period were designated as the SES group and 256 patients with 307 lesions treated with bare metal stents (BMS) in the preceding 1 year were the BMS group. Of these, 166 patients with 216 lesions (88 patients with 121 lesions in the SES group and 78 patients with 95 lesions in the BMS group) received maintenance HD 3 times a week. In advance, we excluded patients who were diagnosed with acute myocardial infarction (MI), underwent bypass grafting, had a contraindication for the use of aspirin and/or ticlopidine, or were >85 years of age.Lesions were suitable for PCI if they were de novo

A larger plaque volume and lipid-rich plaque may be indicative of embolic events after stent implantation, resulting in myocardial injury.

Metabolic syndrome is associated with lipid-rich plaques, contributing to the increasing risk of plaque vulnerability.

GNRI significantly associated with cardiac events after elective PCI. Further studies should be performed to establish appropriate therapeutic strategies for this vulnerable patient group.

No abstract