Are Patients With Renal Failure Good Candidates for Percutaneous Coronary Revascularization in the New Device Era?

Rubenstein, Mark H.; Harrell, Lari; Sheynberg, Boris V.; Schunkert, Heribert; Bazari, Hasan; Palacios, Igor F.

doi:10.1161/01.cir.102.24.2966

Cited by 192 publications

(106 citation statements)

References 27 publications

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“…17 Mild RI may portend a risk of adverse outcomes and mortality similar to that of more severe renal impairment in patients undergoing PCI. 13 The prognosis of patients with AMI treated medically is significantly diminished in patients with RI. 4,11,12 On the basis of the results of the present study, patients with AMI undergoing primary PCI may now be added to the list of conditions for which baseline RI signifies a markedly worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…RI has been shown to worsen the prognosis of patients with AMI treated medically. 4,8,11,12 Although the existence of RI in patients undergoing percutaneous coronary intervention (PCI) in the non-AMI setting portends a poor prognosis, 13 the outcomes of primary PCI in patients with AMI and RI have not been well characterized, because such patients are typically excluded from clinical trials. 14, 15 We therefore sought to evaluate the impact of RI in a large, contemporary randomized trial of patients undergoing primary PCI for AMI.…”

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confidence: 99%

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Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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Background-The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized. Methods and Results-PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) Յ60 mL/min. RI at baseline was present in 18% of patients. Compared with patients without RI, patients with RI were older and were more likely to be female; to have hypertension, peripheral vascular disease, or cerebrovascular disease; and to present in heart failure. Mortality was markedly increased in patients with versus without baseline RI both at 30 days (7.5% versus 0.8%, PϽ0.0001) and at 1 year (12.7% versus 2.4%, PϽ0.0001). Mortality rates increased incrementally for every 10-mL/min decrease in baseline CrCl. By multivariate analysis, reduced baseline CrCl was a powerful independent predictor of 30-day mortality (hazard ratio, 5.77; PϽ0.0001) and remained associated with reduced survival at 1 year (hazard ratio, 1.98; Pϭ0.08). Hemorrhagic complications and transfusion requirements were also increased more than 2-fold in patients with RI, as were severe restenosis (diameter stenosis Ն70%; 20.6% versus 11.8%, Pϭ0.024) and infarct artery reocclusion (14.7% versus 7.3%, Pϭ0.02). Conclusions-Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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“…Mild renal impairment has been identified as an important predictor of adverse events in patients who have previous cardiovascular disease. [5][6][7][8][9][10][11][12] Although diureticbased blood pressure control and long-term ramipril therapy have been reported to improve clinical outcomes, the hazardous effect of mild renal impairment was only partly decreased by these therapies. 11,13 Pravastatin has recently been shown to decrease the incidence of events in patients who have renal dysfunction; in contrast to most reports, the presence of renal impairment did not influence late clinical outcomes in that study.…”

Section: Discussionmentioning

confidence: 99%

Long-term fluvastatin reduces the hazardous effect of renal impairment on four-year atherosclerotic outcomes (a LIPS substudy)

Lemos

Serruys

Feyter

et al. 2005

The American Journal of Cardiology

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I n the recent Lescol Intervention Prevention Study (LIPS), long-term therapy with fluvastatin decreased the incidence of cardiac events in patients who underwent percutaneous coronary intervention. 1 The present study analyzed the results of LIPS to investigate (1) the effect of baseline renal function on occurrence of long-term adverse events, (2) whether therapy with fluvastatin decreased the expected hazardous effect of renal impairment, (3) the effect of fluvastatin on renal function during follow-up, and (4) the relation between changes in renal function over time and the occurrence of adverse events. METHODS Study design and patient population:The study design and primary results of LIPS have been described elsewhere. 1 Briefly, after a first successful percutaneous coronary intervention (residual stenosis Ͻ50%, absence of postprocedural in-hospital myocardial necrosis, repeat revascularization, or death), patients were randomized to receive fluvastatin therapy (Lescol, Novartis Pharma AG, Basel, Switzerland; 40 mg 2 times daily) or placebo for 3 to 4 years.At enrollment, patients had to fulfill Ն1 of the following lipid profile criteria: (1) total cholesterol level of 135 to 270 mg/dl with a fasting triglyceride level Ͻ400 mg/dl, (2) total cholesterol level Ͻ212 mg/dl for patients whose lipids levels were measured 24 hours to 4 weeks after an episode of myocardial infarction, or (3) total cholesterol level Ͻ232 mg/dl for patients who had diabetes mellitus. Exclusion criteria included a baseline serum creatinine value Ͼ1.8 mg/dl. The study protocol was approved by the local ethics committees, and all patients gave informed written consent.Lipoproteins and evaluation of renal function: Each patient was clinically evaluated Ն8 times after randomization. Blood lipid levels were measured at all visits, and serum creatinine was measured at baseline

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“…Renal insufficiency, or creatinine levels > 1.5 in elderly patients submitted to percutaneous interventions, is associated with a higher comorbidity rate and is an independent indicator of more adverse coronary events 7,8 . Recent publications have emphasized, on a regular basis, the beneficial effects of administering N-acetylcysteine before any procedures 9,10 .…”

Section: Discussionmentioning

confidence: 99%

Estado da arte do procedimento percutâneo: paciente octogenário submetido com sucesso, em apenas uma sessão, a valvotomia pulmonar, implante de stent coronário e implante de marcapasso definitivo

Filho¹,

Neto²,

Cividanis³

et al. 2005

Arq. Bras. Cardiol.

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This report describes a case involving an 82 year old patient with mild renal insufficiency, severe pulmonary valve stenosis (PVS), severe anterior descending artery stenosis and complete atrioventricular block, who successfully underwent, in a single session, coronary angioplasty and a stent implant, pulmonary valvotomy and a permanent pacemaker implant.Coronary percutaneous interventions with stent implants are extensively used in the treatment of coronary patients, including octogenarians 1-5 . PVS, frequently diagnosed and treated during childhood or adolescence, is rarely found in octogenarian patients. Percutaneous treatment of PVS is a safe and efficient procedure 6 .A cardiac conduction system disease in an octogenarian is common and an indication for a permanent pacemaker implant is frequently recommended.Our report refers to an octogenarian patient with severe PVS, a serious lesion in the mid third of the anterior descending artery and complete atrioventricular block (CAVB). This patient was submitted successfully to three consecutive procedures in the cardiac catheterization laboratory: pulmonary valvotomy, coronary stent implant and permanent pacemaker implant. CASE REPORTThe patient is an 82 year old male in good general condition, with dyspnea for two months, progressively increasing from moderate to mild exertions. A physical examination presented blood pressure (BP) of 150/90 mmHg, cardiac frequency of 60 beats per minute and a systolic ejection murmur ++/4 over the pulmonary area radiating toward the left sternal edge. The chest x-rays show a cardiac silhouette within normal limits, pulmonary vasculature within normal limits, prominent dilation of the pulmonary artery trunk, pulmonary parenchyma within normal limits, blunted cardiophrenic and costophrenic angles. An electrocardiogram, taken ninety days earlier, revealed a sinus rhythm, CF of 60 bpm, SAQRS between 90 and 180 degrees and an increased strain on the right chambers. The laboratory tests presented creatinine levels of 2.3 mg/ml and urea of 60 mg/ml. The echocardiogram revealed severe PVS and an alteration in the left ventricle relaxation phase.The procedure was performed after renal preparation. The patient was adequately hydrated and given 600 mg of N-acetylcysteine every twelve hours, maintaining the drug administration for 48 hours.The hemodynamic study confirmed severe pulmonary valve stenosis with a systolic gradient of 80 mmHg (PT = 20/10 mmHg and RV = 100/8 mmHg). anterior descending artery presented eccentric stenosis, 70% ulcerated in its mid third; the other arteries presented discrete wall motion irregularities. The left ventricle (LV) presented normal contractile function. The renal preparation was performed before the procedure with adequate hydration and previous administration of Nacetylcysteine for 48 hours as well as antiplatelet therapy with ASA and clopidogrel in the normal dosages. There was a reduction in the levels of creatinine and urea to 1 mg/ml and 40 mg/ml, respectively.On the day of the procedure, during ad...

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Are Patients With Renal Failure Good Candidates for Percutaneous Coronary Revascularization in the New Device Era?

Cited by 192 publications

References 27 publications

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Long-term fluvastatin reduces the hazardous effect of renal impairment on four-year atherosclerotic outcomes (a LIPS substudy)

Estado da arte do procedimento percutâneo: paciente octogenário submetido com sucesso, em apenas uma sessão, a valvotomia pulmonar, implante de stent coronário e implante de marcapasso definitivo

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