Impact of moderate or severe renal insufficiency on long-term outcomes in patients undergoing drug-eluting stent based coronary intervention

Zhang, Rui Yan; Zhu, Zheng Bin; Zhang, Qi; Yang, Zhen; Hu, Jian; Lv, An Kang; Zhang, Jian Sheng; Shen, Wei Feng

doi:10.1016/j.ijcard.2008.04.028

Cited by 32 publications

(32 citation statements)

References 36 publications

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“…Renal impairment may be a marker for undiagnosed vascular disease or severity of vascular damage. It is also possible that atherogenic effects of traditional risk factors such as tobacco use, hyperlipidemia, hypertension, and diabetes may be greater in the presence of moderate to severe renal failure, which could also contribute to an increase in progression of CAD, MI and late mortality (19).…”

Section: Discussionmentioning

confidence: 99%

Chromosome 9p21 polymorphism is associated with myocardial infarction but not with clinical outcome in Han Chinese

Peng¹,

Lü²,

Zhang³

et al. 2009

Clinical Chemistry and Laboratory Medicine

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Background: rs1333049 polymorphism on chromosome 9p21 has been shown to affect susceptibility to coronary artery disease (CAD) in Caucasians. This study examined the association of rs1333049 with myocardial infarction (MI), angiographic severity of CAD and clinical outcome after a first acute MI in Han Chinese. Methods: rs1333049 polymorphism was genotyped in 520 patients with a first acute MI and in 560 controls. The number of angiographically documented diseased coronary arteries (luminal diameter stenosis G50%), echocardiographic left ventricular ejection fraction (LVEF), and major adverse cardiac events (MACE) during follow-up (mean, 29"15 months) were recorded. Results: Patients with MI had higher frequencies of the CC genotype (30.0% vs. 20.7%) or C allele (55.5% vs. 46.2%) compared with controls (all p-0.01). rs1333049 polymorphism was strongly associated with MI wodds ratio (OR) 1.48, 95% confidence interval (CI) 1.22-1.79x after adjusting for traditional risk factors. Although longer hospitalization stay was observed in patients with the rs1333049-C allele, this polymorphism was not related to angiographic severity of CAD, LVEF, and occurrence of MACE after MI. Conclusions: This study demonstrates an association of rs1333049 polymorphism locus on chromosome 9p21 with risk for MI, but not with post-MI prognosis in Han Chinese. Clin Chem Lab Med 2009;47:917-22.

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Section: Discussionmentioning

confidence: 99%

Chromosome 9p21 polymorphism is associated with myocardial infarction but not with clinical outcome in Han Chinese

Peng¹,

Lü²,

Zhang³

et al. 2009

Clinical Chemistry and Laboratory Medicine

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“…Patients with RI have more unfavorable lipid profiles, elevated serum homocysteine and cytokine levels, aggressive atherosclerosis, endothelial dysfunction, and increased prothrombotic activity. 2,20 Furthermore, plasma asymmetric dimethylarginine (ADMA) is increased in patients with chronic RI, even at early stages. ADMA is a naturally occurring amino acid that competitively inhibits the activity of nitric oxide synthase; elevated plasma ADMA levels are associated with endothelial dysfunction.…”

Section: Baseline Patient Characteristicsmentioning

confidence: 99%

“…ADMA is a naturally occurring amino acid that competitively inhibits the activity of nitric oxide synthase; elevated plasma ADMA levels are associated with endothelial dysfunction. 2,21 Preprocedural plasma ADMA levels may independently predict subsequent adverse cardiovascular events in patients undergoing PCI. 22 …”

Section: Baseline Patient Characteristicsmentioning

confidence: 99%

“…13 In the current review, we tallied the outcomes of 12,189 patients with various degrees of chronic RI who underwent DES implantation in 16 studies. [2][3][4][5]24,38,42,45,53,[57][58][59][60][61][62][63] Ten studies compared DES and BMS use [3][4][5]38,42,53,57,60,61,63 ; the DES subtype was specified in 12 studies (SES ). One study reported on all 3 types of stents in chronic RI.…”

Section: Impact Of Chronic Ri On Outcomes After Des Usementioning

confidence: 99%

“…[1][2][3][4][5] In patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI), even mild RI is an independent predictor of worse outcomes. 1 Renal insufficiency is a potent risk factor for CAD and qualifies as a coronary risk equivalent.…”

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Use of Drug-Eluting Stents in Patients With Coronary Artery Disease and Renal Insufficiency

El‐Menyar

Suwaidi

Holmes

2010

Mayo Clinic Proceedings

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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 EBS-CO 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. © 2010 Mayo Foundation for Medical Education and ResearchR enal insufficiency (RI), defined as creatinine clearance lower than or equal to 60 mL/min, is prevalent in patients with coronary artery disease (CAD). [1][2][3][4][5] In patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI), even mild RI is an independent predictor of worse outcomes.1 Renal insufficiency is a potent risk factor for CAD and qualifies as a coronary risk equivalent. Chronic RI not only increases cardiovascular event risk but also is associated with worse outcomes if an event occurs. 6 Diagnostic coronary angiography and PCI are used less frequently in patients with reduced renal function; risk of complications from these procedures is increased in the presence of RI. 7,8 This increased risk has been shown to occur at even moderate levels of RI, despite the use of advanced stent technology and optimal adjunctive medical therapy. Best et al 10 reported an RI prevalence of 49.1% in patients undergoing elective PCI. In that study, RI had a negative impact similar to that of diabetes mellitus (DM) on cardiovascular outcomes.10 One year after PCI, chronic RI was associated with a doubling of mortality in patients with mild RI, a 5-fold increase in patients with moderate RI, and a 12-fold increase in patients with severe RI. 10 In primary PCI for myocardial infarction (MI), a notable incremental reduction in survival was evident for each decline of 10 mL/min in creatinine clearance.11 Unfortunately, most randomized trials of patients undergoing PCI have excluded patients with severe RI. 12,13 This narrative review aims to identify the impact of a drug-eluting stent (DES) in the performance of PCI in patients with RI. METHODSWe evaluated the impact of RI on the pathogenesis of CAD and outcomes after PCI (in the form of DES implantation) in these high...

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Chronic kidney disease and the risk of stent thrombosis after percutaneous coronary intervention with drug‐eluting stents

Ming

Zhou

Wang

et al. 2012

Cathet Cardio Intervent

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Impact of moderate or severe renal insufficiency on long-term outcomes in patients undergoing drug-eluting stent based coronary intervention

Cited by 32 publications

References 36 publications

Chromosome 9p21 polymorphism is associated with myocardial infarction but not with clinical outcome in Han Chinese

Chromosome 9p21 polymorphism is associated with myocardial infarction but not with clinical outcome in Han Chinese

Use of Drug-Eluting Stents in Patients With Coronary Artery Disease and Renal Insufficiency

Chronic kidney disease and the risk of stent thrombosis after percutaneous coronary intervention with drug‐eluting stents

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