Clinical Outcome of Percutaneous Transluminal Coronary Rotational Atherectomy in Patients With End-Stage Renal Disease

Abstract

The clinical results of percutaneous transluminal coronary rotational atherectomy (PTCRA) in dialysis patients were retrospectively evaluated in comparison with coronary artery bypass grafting (CABG). From 1997 to 2001, 44 consecutive dialysis patients with 61 lesions underwent PTCRA and 55 consecutive dialysis patients underwent CABG. The initial success rate of PTCRA was 98%. The PTCRA group had a shorter hospital stay (13+/-17 vs 60+/-35 days, p=0.0001) and a lower rate of complications (11% vs 42%, p=0.001) than the CABG group. Although neither event-free survival without death nor myocardial infarction (MI) was significantly different between the CABG and PTCRA groups during the mean follow-up period of 21+/-14 months, 20 patients (45%) in the PTCRA group needed repeat revascularization of the target lesion. In conclusion, PTCRA may be a safe alternative modality for revascularization of high-risk CABG candidates, with excellent short-term results although the long-term outcome is inferior to that of CABG because of the higher restenosis rate.

Optimal Method of Coronary Revascularization in Patients Receiving Dialysis

“…Four studies included patients who underwent repeat revascularization, a larger proportion (22%) of patients in two studies (31,33), and a small proportion (11%) in the remaining 2 studies (25,32). Two of the studies included a small number of patients (13%) who had emergent surgeries (30,32). The weighted mean age of patients was 60 yr, and most relevant characteristics like hyperlipidemia, ejection fraction, hypertension, and diabetes mellitus were similar among those receiving CABG and PCI.…”

“…A cardiac event was defined as a composite outcome of myocardial infarction or need for repeat revascularization in nine studies. (20,22,(25)(26)(27)(28)31,32,35) Eight studies also reported events of myocardial infarction on their own (20,25-27,30 -32,35).…”

“…However, long-term (1 to 8 yr) mortality no longer differed between the two groups (RR 1.01, 95% CI 0.87 to 1.18; P ϭ 0.57) (Figure 2b). Four of the included studies reported long-term mortality and cardiac events at different lengths of follow up for those who received CABG compared with those who received PCI (25,26,30,32). We repeated the meta-analysis, including only those studies that had the same length of follow-up for both groups.…”

“…In some studies, it was unclear whether baseline coronary artery atherosclerosis was similar in those receiving CABG compared with those receiving PCI. Patients with single-vessel disease or those too ill to undergo CABG may be more likely to receive PCI; if patients in one of the groups had more unfavorable coronary anatomy, this could confound the results (25,31,32). Similarly, some studies also included patients who underwent emergent revascularization with either CABG or PCI (30,32).…”

“…Patients with single-vessel disease or those too ill to undergo CABG may be more likely to receive PCI; if patients in one of the groups had more unfavorable coronary anatomy, this could confound the results (25,31,32). Similarly, some studies also included patients who underwent emergent revascularization with either CABG or PCI (30,32). When considering the need for repeat revascularization outcome, the number of new coronary artery lesions could not be distinguished from old ones.…”