Impact of renal insufficiency on clinical and angiographic outcomes following percutaneous coronary intervention with sirolimus‐eluting stents

Nakazawa, Gaku; Tanabe, Kengo; Aoki, Jiro; Yamamoto, Hiroaki; Higashikuni, Yasutomi; Onuma, Yoshinobu; Yachi, Sen; Nakajima, Hiroyuki; Hara, Kazuhiro

doi:10.1002/ccd.21016

Cited by 68 publications

(59 citation statements)

References 21 publications

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“…Previous studies also demonstrated that major adverse cardiac events and target lesion revascularization rates after SES implantation in HD patients were higher than those of non-HD patients, regardless of the beneficial effect of SESs. 13,14) In the present study, the incidences of any clinical event (50.0%) and target lesion revascularization (33.3%) in the HD group were significantly higher than those of the non-HD group. However, the incidence of target lesion revascularization after BMS implantation in HD patients was 56.3% in the BMS period (from January 2003 to August 2004) at Sapporo Social Insurance General Hospital.…”

Section: Discussionmentioning

confidence: 40%

Comparison of Long-Term Clinical Outcome After Sirolimus-Eluting Stent Implantation in Patients With and Without Hemodialysis

Sasao¹,

Hotta

Maeda

et al. 2007

Int. Heart J.

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SUMMARYPoor clinical outcomes for hemodialysis (HD) patients compared to non-HD patients after coronary intervention have been reported. Although coronary intervention using sirolimus-eluting stents (SESs) might be expected to reduce restenosis in HD patients, little is known about the efficacy of the SESs. The purpose of the present study was to compare the clinical and angiographic outcomes of HD patients with non-HD patients after SES implantation. The study population consisted of 170 consecutive patients (234 lesions) who had undergone successful coronary SES implantation. The patients were classified into 2 groups, an HD group (18 patients, 27 lesions) and a non-HD group (152 patients, 207 lesions). The incidence of any clinical event was significantly higher in the HD group than in the non-HD group (50.0% versus 12.5%, P < 0.0001). Target lesion revascularization was necessary in 6 patients (33.3%) in the HD group and in 7 patients (4.6%) in the non-HD group (P < 0.0001). The Cox proportional-hazards regression model on cardiac events identified HD patients (P = 0.0301, hazard ratio = 2.704) as an explanatory factor. Moreover, the Cox proportional-hazards regression model on target lesion revascularization identified HD (P = 0.0004, hazard ratio = 6.921) and in-stent restenosis lesion (P = 0.0293, hazard ratio = 3.323) as explanatory factors. The present study suggests that compared with non-HD patients, HD patients with coronary artery disease treated by SESs have a poorer clinical outcome. (Int Heart J 2007; 48: 689-700) Key words: Sirolimus-eluting stents, Hemodialysis, Clinical outcome HEMODIALYSIS (HD) patients are well known to be a high risk population for coronary artery disease. 1) Moreover, poor clinical outcomes compared to non-HD patients after coronary intervention have been reported. 2,3) Previous studies of sirolimus-eluting stents (SESs) compared with bare-metal stents (BMSs) in coronary artery disease have demonstrated a reduction in the incidence of cardiac events related to recurrent ischemia and lower rates of angiographic restenosis. 4-7)From the

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Section: Discussionmentioning

confidence: 40%

Comparison of Long-Term Clinical Outcome After Sirolimus-Eluting Stent Implantation in Patients With and Without Hemodialysis

Sasao¹,

Hotta

Maeda

et al. 2007

Int. Heart J.

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“…The higher prevalence of high platelet reactivity in the CKD population might be another potential explanation for the higher incidence of nonfatal target vessel MI in the CR group than in the IR group among CKD patients. This finding suggests that excessive PCI with DES implantation might be associated with procedure‐related or stent‐related long‐term adverse outcomes rather than the benefit of revascularization as previous studies have suggested 1, 33, 34…”

Section: Discussionmentioning

confidence: 69%

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Kim

Lee

Choi

et al. 2018

JAHA

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BackgroundThere are limited data regarding the prognostic impact of angiographic complete revascularization (CR) in patients with chronic kidney disease (CKD). We sought to investigate the differential prognostic impact of angiographic CR over incomplete revascularization (IR), according to the presence of CKD in the drug‐eluting stent era.Methods and ResultsBetween 2003 and 2011 at Samsung Medical Center, consecutive patients with multivessel disease were stratified by the presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2) and classified according to angiographic CR (residual SYNTAX score=0) or IR. Clinical outcomes were compared between angiographic CR and IR, stratified by the presence of CKD. Primary outcome was patient‐oriented composite outcomes (POCO, a composite of all‐cause death, myocardial infarction, any revascularization) at 3 years. Inverse probability weighting was performed between the CR and IR groups. A total of 3224 patients were eligible for analysis: 2295 without CKD; 929 with CKD. Among non‐CKD patients, angiographic CR showed a significantly lower risk of POCO than IR (17.2% versus 21.7%, adjusted hazard ratio 0.76, 95% confidence interval, 0.62–0.95, P=0.014), mainly driven by a significantly lower risk of any revascularization. Among CKD patients, however, angiographic CR was associated with a significantly higher risk of POCO than IR (37.7% versus 28.4%, adjusted hazard ratio 1.42, 95% confidence interval, 1.08%–1.85%, P=0.011), mainly driven by a significantly higher risk of nonfatal target vessel myocardial infarction.ConclusionsAngiographic CR was associated with reduced risk of POCO than IR in patients without CKD; however, it was associated with a significantly higher risk of POCO and nonfatal myocardial infarction in CKD patients.

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“…Although interventional strategies have been tried to overcome atherosclerosis in patients on HD, beneficial effects are limited. For example, patients with end-stage renal failure on hemodialysis and treated with drug-eluting stents for coronary artery disease are at high risk of restenosis after PCI (18,19), although drugeluting stents significantly reduce the risk of restenosis after PCI in many patients (20 -24). Under such conditions, significant improvement in long-term clinical outcome was observed with cilostazol in the study presented here.…”

Section: Discussionmentioning

confidence: 99%

Cilostazol Improves Long-Term Patency after Percutaneous Transluminal Angioplasty in Hemodialysis Patients with Peripheral Artery Disease

Ishii

Kumada

Toriyama

et al. 2008

Clinical Journal of the American Society of Nephrology

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Impact of renal insufficiency on clinical and angiographic outcomes following percutaneous coronary intervention with sirolimus‐eluting stents

Cited by 68 publications

References 21 publications

Comparison of Long-Term Clinical Outcome After Sirolimus-Eluting Stent Implantation in Patients With and Without Hemodialysis

Comparison of Long-Term Clinical Outcome After Sirolimus-Eluting Stent Implantation in Patients With and Without Hemodialysis

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Cilostazol Improves Long-Term Patency after Percutaneous Transluminal Angioplasty in Hemodialysis Patients with Peripheral Artery Disease

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