The renal patient with coronary artery disease

Gupta, Rajiv; Birnbaum, Yochai; Uretsky, Barry F.

doi:10.1016/j.jacc.2004.06.058

Cited by 71 publications

(22 citation statements)

References 117 publications

(91 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8,33 Second, reduced PCI procedural success has been reported to occur more frequently in patients with CKD, further highlighting the risk of incomplete revascularization in these patients. 5,9,34 Third, it has been postulated that CABG provides prophylactic protection of future coronary events by virtue of bypassing vulnerable plaques that are commonly located in the proximal coronary tree. 35 Existing studies suggest that patients with CKD undergoing CABG have high postoperative events when compared with their preserved renal function counterparts with respect to mortality, stroke, reoperation, and deep sternal infection.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Treatment by Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery in Patients With Chronic Kidney Disease Undergoing Index Revascularization in Ontario

Chan

Ivanov

et al. 2015

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

Background— There is a paucity of data on the comparative effectiveness of percutaneous coronary intervention using contemporary drug-eluting stent (DES) compared with coronary artery bypass graft (CABG) surgery in patients with chronic kidney disease. Methods and Results— A population-based study was performed using the Cardiac Care Network, a provincial registry of all patients undergoing cardiac catheterization in Ontario, to evaluate patients treated with either percutaneous coronary intervention using DES or CABG between October 1, 2008, and September 30, 2011. Chronic kidney disease was defined as creatinine clearance <60 mL/min. A total of 1786 propensity-matched patients from 4006 patients with chronic kidney disease undergoing index revascularization for multivessel disease with either DES or isolated CABG (n=893 each group) were analyzed. Baseline and procedural characteristics between percutaneous coronary intervention and CABG groups were well-balanced, including urgent revascularization priority, diabetes mellitus, left ventricular function, and 3-vessel disease. The 1-, 2-, and 3-year Kaplan–Meier survival analyses in propensity-matched patients favored CABG (93.2% versus 89.3%; 86.6% versus 80.3%; 80.8% versus 71.5%, respectively; P <0.001). The CABG cohort had greater 1-, 2-, and 3-year freedom from major adverse cardiac and cerebrovascular events (89.4% versus 71.2%; 81.9% versus 60.5%; 75.2% versus 51.8%, respectively; P <0.001). Cox regression analysis identified DES use to be associated with greater hazard for late mortality (hazard ratio, 1.58; 95% confidence interval, 1.32–1.90) and major adverse cardiac and cerebrovascular events (2.62; 2.28–3.01; all P <0.001). Conclusions— In this large provincial registry, CABG was associated with improved early and late clinical outcomes when compared with percutaneous coronary intervention using DES in patients with chronic kidney disease undergoing index revascularization.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Treatment by Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery in Patients With Chronic Kidney Disease Undergoing Index Revascularization in Ontario

Chan

Ivanov

et al. 2015

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

show abstract

“…BP should be optimized before surgery. Current recommendations for long-term CRF management set a BP goal of lower than 130/80 mmHg 13. Preoperative BP in our patient was high (180/110 mmHg).…”

Section: Discussionmentioning

confidence: 56%

Safe spinal anesthesia in a woman with chronic renal failure and placenta previa

Zencirci¹

2010

IJGM

View full text Add to dashboard Cite

Background:Chronic renal failure is strongly associated with poor pregnancy outcome. Women dependent on hemodialysis before conception rarely achieve a successful live birth.Case presentation:A 31-year-old multiparous Turkish woman was scheduled for cesarean section under spinal anesthesia at 37 weeks and five days’ gestation because of hemorrhage due to secondary placenta previa. Spinal anesthesia with 8 mg of hyperbaric bupivacaine was successfully performed. Invasive blood pressure, central venous pressure, and heart rate were stable during the surgery. The mother returned to regular hemodialysis on the first postoperative day.Conclusion:Pregnancy is uncommon in women with chronic renal failure requiring chronic dialysis. Rates of maternal hypertension, pre-eclampsia, anemia, and infection in the pregnant chronic dialysis patient are high. However, our findings suggest that with careful, close, and effective monitoring preoperatively and intraoperatively, spinal anesthesia can be safely performed for cesarean section in patients undergoing hemodialysis.

show abstract

“…Therefore, cardiac procedures, especially myocardial revascularization, to relieve ischemic insult is the best treatment for patients with renal insufficiency having ischemic heart disease. In particular, when comparing myocardial revascularization with PCI in patients receiving RRT, there may be better long-term survival and freedom from angina with myocardial revascularization, compared with balloon angioplasty [16]. …”

Section: Discussionmentioning

confidence: 99%

On-Pump versus Off-pump Myocardial Revascularization in Patients with Renal Insufficiency: Early and Mid-term Results

Kim

Lee

et al. 2011

Korean J Thorac Cardiovasc Surg

View full text Add to dashboard Cite

BackgroundMyocardial revascularization in patients with renal insufficiency is challenging to the cardiac surgeon, irrespective of utilizing extracorporeal circulation. This study aimed to compare the number of bypass grafts and the mid-term results and to evaluate independent survival predictors in patients with renal insufficiency undergoing on-pump or off-pump myocardial revascularization.Materials and MethodsWe retrospectively analyzed the data of 103 patients with renal insufficiency, who had isolated myocardial revascularization between January 1999 and January 2009. The patients were divided into two groups, the on-pump group and the off-pump group.ResultsThe off-pump group received a significantly greater number of distal arterial grafts than the on-pump group. However, the mean number of total grafts, the degree of complete revascularization, and survival rate of the patients were not significantly different between the two groups. Multivariate analysis showed the independent predictors for reduced mid-term survival were the number of total grafts and postoperative periodic renal replacement therapy. Off-pump myocardial revascularization does not decrease the number of bypass grafts or influence on the mid-term results for patients with renal insufficiency, compared to on-pump myocardial revascularization.ConclusionMyocardial revascularization with a large number of total grafts has a beneficial effect on survival in patients with renal insufficiency, irrespective of utilizing extracorporeal bypass.

show abstract

The renal patient with coronary artery disease

Cited by 71 publications

References 117 publications

Clinical Outcomes of Treatment by Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery in Patients With Chronic Kidney Disease Undergoing Index Revascularization in Ontario

Clinical Outcomes of Treatment by Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery in Patients With Chronic Kidney Disease Undergoing Index Revascularization in Ontario

Safe spinal anesthesia in a woman with chronic renal failure and placenta previa

On-Pump versus Off-pump Myocardial Revascularization in Patients with Renal Insufficiency: Early and Mid-term Results

Contact Info

Product

Resources

About