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Hu H, Wang S, Tang G, Zhai C, Shen L. Impact of anemia on in-stent restenosis after percutaneous coronary intervention. BMC Cardiovasc Disord 2021; 21:548. [PMID: 34798833 PMCID: PMC8603472 DOI: 10.1186/s12872-021-02355-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background Anemia is a common risk factor for post-percutaneous coronary intervention (PCI) adverse events; however, data on its association with in-stent restenosis (ISR) is limited. Methods 538 patients who underwent PCI between January 2017 and September 2019 and follow-up angiography 9–12 months after the initial PCI were enrolled in this study. Baseline clinical and procedural characteristics were compared between the ISR and non-ISR groups, and independent predictors of ISR were determined using propensity score matching. Results The incidence of anemia was 53.5% in patients with ISR and 19.0% in those without ISR. Univariable logistic regression analyses showed that anemia (OR, 4.283; 95% CI, 1.949–9.410; P < 0.001), diabetes mellitus (OR, 2.588; 95% CI, 1.176–5.696; P = 0.018), chronic kidney disease (OR, 3.058; 95% CI, 1.289–7.252; P = 0.011), multiple stenting (OR, 2.592; 95% CI, 1.205–5.573; P = 0.015), bifurcation lesion (OR, 2.669; 95% CI, 1.236–5.763; P = 0.012), and calcification (OR, 3.529; 95% CI, 1.131–11.014; P = 0.030) were closely associated with ISR. Low-density lipoprotein cholesterol (LDL-c) levels and stent diameter were also significantly linked to ISR, as was anemia (P = 0.009) after propensity score matching. Conclusion Anemia is closely associated with post-PCI ISR, and patients with lower hemoglobin levels are at a higher risk of ISR.
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Affiliation(s)
- Huilin Hu
- Department of Cardiology, Affiliated Hospital of Jiaxing University, No.1882 Zhonghuan South Road, Jiaxing, Zhejiang, China
| | - Shijun Wang
- Department of Cardiology, Affiliated Hospital of Jiaxing University, No.1882 Zhonghuan South Road, Jiaxing, Zhejiang, China
| | - Guanmin Tang
- Department of Cardiology, Affiliated Hospital of Jiaxing University, No.1882 Zhonghuan South Road, Jiaxing, Zhejiang, China
| | - Changlin Zhai
- Department of Cardiology, Affiliated Hospital of Jiaxing University, No.1882 Zhonghuan South Road, Jiaxing, Zhejiang, China
| | - Liang Shen
- Department of Cardiology, Affiliated Hospital of Jiaxing University, No.1882 Zhonghuan South Road, Jiaxing, Zhejiang, China.
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Coyle M, Flaherty G, Jennings C. A critical review of chronic kidney disease as a risk factor for coronary artery disease. IJC HEART & VASCULATURE 2021; 35:100822. [PMID: 34179334 PMCID: PMC8213912 DOI: 10.1016/j.ijcha.2021.100822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/14/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
Chronic kidney disease (CKD) is a significant risk factor for cardiovascular disease (CVD). In addition to common CVD risk factors, the presence of CKD is independently associated with an elevated cardiovascular (CV) risk. We examined the association between CKD and CVD, focusing on coronary artery disease (CAD) in both primary and secondary CVD. A total of 94 articles were included for this review using search strategies on Pubmed and Google scholar. The main findings of our review included that besides sharing common risk factors, CKD induces several physiological microscopic changes leading to increased CV risk. These microscopic changes manifest macroscopically with evidence of the development of primary CAD in CKD patients, in addition to accelerating CAD in those with pre-established CV pathology, with CKD consequently being a risk factor for both primary and secondary CAD progression. Current CV guideline recommendations do not discriminate between those patients with and without CKD. Future research is needed in this area, examining if there may be a role for tighter modifiable risk factor targets in this high-risk population.
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Affiliation(s)
- Mark Coyle
- Corresponding author at: National Institute for Prevention and Cardiovascular Health, Galway, Ireland.
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Xu X, Zhou F, Hua Y, Liu B, Wang L, Hou W, Xia M. Current Smoking is a Risk Factor for the Irregular Surface and Calcification of Carotid Plaque in Men. Int J Gen Med 2021; 14:3989-3997. [PMID: 34349548 PMCID: PMC8326222 DOI: 10.2147/ijgm.s295921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To explore whether current smoking could influence plaque characteristics and determine its correlation to the irregular surface and calcification of carotid plaque. Methods Three hundred and seventeen patients with severe carotid atherosclerosis stenosis (SCAS) detected by color duplex flow imaging (CDFI) and confirmed by CT angiography (CTA) were recruited. The results of laboratory parameters were collected by using electronic database of the hospital. Computerized tomography (CT) scanning and high-resolution ultrasonography were performed for assessment of plaque morphology, respectively. Results All enrolled smokers and non-smokers had no significant difference among all characteristics not related to smoking. CT scanning could efficiently identify the difference among enrolled smokers and non-smokers not only for the characteristics related to smoking but also the onsets of carotid plaque. Surface morphology was also efficiently detected by ultrasonography. Further ridge trace analysis showed that ultrasonography is efficient for diagnosis of calcified plaque compared with gold standard for plaque diagnosis. Further correlation analysis showed that ultrasonography parameters could offer reliable evidence for plaque scores, which was associated with age index. Ultrasonography parameters could efficiently differentiate plaque morphologies among enrolled smokers and never-smokers. Conclusion Current smoking was positively associated with plaque calcification onsets, and smoking cessation could efficiently attenuate such injury. High-frequency ultrasound can clearly distinguish the details of calcification with promising clinical significance for current smoking patients.
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Affiliation(s)
- Xiangli Xu
- Department of Ultrasound, The Second Hospital of Harbin, Harbin, People's Republic of China
| | - Fubo Zhou
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Beibei Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lili Wang
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Weihong Hou
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Mingyu Xia
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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4
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Chen H, Yu X, Ma L. Risk factors of contrast-induced nephropathy in patients with STEMI and pump failure undergoing percutaneous coronary intervention. Exp Ther Med 2020; 21:140. [PMID: 33456507 PMCID: PMC7791920 DOI: 10.3892/etm.2020.9572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022] Open
Abstract
Risk factors associated with the development of contrast-induced nephropathy (CIN) remain poorly defined in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The present study was designed to assess the association between the Killip grade and the development of CIN in patients with STEMI and pump failure undergoing PCI. Data were retrospectively collected from the records of patients with STEMI and pump failure from the Chinese Society of Cardiology and American Heart Association database. A total of 7,471 patients were analyzed, including 5,521 patients with Killip grade II, 878 with Killip III and 1,072 with Killip IV pump failure. Patients were classified into two groups: Those undergoing primary PCI (PPCI; n=5,063) and those undergoing elective PCI (EPCI; n=2,408). Patients in the PPCI group had higher cardiac arrest rates, lower blood pressure and higher cholesterol levels as compared to the EPCI group. There was a statistically significant difference in the rates of CIN with Killip II pump failure in the PPCI group as compared to the EPCI group, but not in those with Killip III and VI pump failure. Logistic regression analysis indicated that the Killip classification is a risk predictor for post-PCI CIN. The present results indicated a positive association between the Killip grade and post-PCI CIN in patients with STEMI and pump failure. In addition, patients with STEMI and Killip grade II pump failure were at a higher risk of PCI after PPCI as compared to EPCI. Further prospective studies are required to confirm the present results.
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Affiliation(s)
- Hongwu Chen
- Department of Cardiology, Division of Life Sciences and Medicine, The First Affiliated Hospital of the University of Science and Technology of China (USTC), USTC, Hefei, Anhui 230001, P.R. China.,Anhui Institute of Cardiovascular Diseases, Hefei, Anhui 230001, P.R. China
| | - Xiaofan Yu
- Department of Cardiology, Division of Life Sciences and Medicine, The First Affiliated Hospital of the University of Science and Technology of China (USTC), USTC, Hefei, Anhui 230001, P.R. China.,Anhui Institute of Cardiovascular Diseases, Hefei, Anhui 230001, P.R. China
| | - Likun Ma
- Department of Cardiology, Division of Life Sciences and Medicine, The First Affiliated Hospital of the University of Science and Technology of China (USTC), USTC, Hefei, Anhui 230001, P.R. China.,Anhui Institute of Cardiovascular Diseases, Hefei, Anhui 230001, P.R. China
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Kim DW, Om SY, Park MW, Park HW, Lee PH, Kang DY, Ahn JM, Lee CW, Park SW, Park SJ, Her SH, Park DW. Comparative effectiveness analysis of percutaneous coronary intervention versus coronary artery bypass grafting in patients with chronic kidney disease and unprotected left main coronary artery disease. EUROINTERVENTION 2020; 16:27-35. [DOI: 10.4244/eij-d-18-01206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lin MJ, Lee J, Chen CY, Huang CC, Wu HP. Chronic kidney disease and diabetes associated with long-term outcomes in patients receiving percutaneous coronary intervention. BMC Cardiovasc Disord 2017; 17:242. [PMID: 28893175 PMCID: PMC5594538 DOI: 10.1186/s12872-017-0673-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/27/2017] [Indexed: 12/18/2022] Open
Abstract
Background The effect of diabetes mellitus (DM) and chronic kidney disease (CKD) on long-term outcomes in patients receiving percutaneous coronary intervention (PCI) is unclear. Methods A total of 1394 patients who underwent PCI were prospectively enrolled and divided into 4 groups according to the presence or absence of DM or CKD. Baseline characteristics, risk factors, medications, and angiographic findings were compared. Determinants of long-term outcomes in patients undergoing PCI were analyzed. Results Patients with DM and CKD had the highest all-cause mortality and cardiovascular mortality (both P < 0.01) but there were no differences existed in myocardial infarction (MI) or repeated PCI among the 4 groups (P = 0.19, P = 0.87, respectively). Patients with DM and CKD had the lowest even-free rate of all-cause mortality, cardiovascular mortality, MI, and repeated PCI (P < 0.001, P < 0.001, P < 0.001, and P = 0.002, respectively). In the Cox proportional hazard model, patients with both DM and CKD had the highest risk of all-cause mortality (HR: 3.25, 95% CI: 1.85–5.59), cardiovascular mortality (HR: 3.58, 95% CI: 1.97–6.49), MI (HR: 2.43, 95% CI: 1.23–4.08), and repeated PCI (HR: 1.79, 95% CI: 1.33–2.41). Patients with CKD alone had the second highest risk of all-cause mortality (HR: 2.04, 95% CI: 1.15–3.63), cardiovascular mortality (HR: 2.13, 95% CI: 1.13–4.01), and repeated PCI (HR: 1.47, 95% CI: 1.09–1.97). Conclusions DM and CKD had additive effect on adverse long-term outcomes in patients receiving PCI; CKD was a more significant adverse predictor than DM.
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Affiliation(s)
- Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical foundation, Taichung, Taiwan.,Department of Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jung Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yu Chen
- Department of Pediatric Emergency Medicine, Changhua Christian Children's Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Chen Huang
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Han-Ping Wu
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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How to balance risks and benefits in the management of CKD patients with coronary artery disease. J Nephrol 2015; 28:403-13. [PMID: 25712237 DOI: 10.1007/s40620-015-0184-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease (CAD), which remains the most common cause of morbidity and mortality in CKD patients. Although the management of CAD is more challenging in patients with CKD than in the general population, and coupled with concerns about further deterioration of renal function and therapy-related toxic effects, CKD patients and those receiving dialysis have not traditionally been included in randomized trials evaluating either medical or revascularization therapies. Thus, only scant data from small prospective studies or retrospective analyses of controlled trials and registries are available, and to date no optimal treatment approach has been defined for this subgroup of patients. However, they potentially have much to gain from the pharmacological, interventional, and surgical strategies used in the general population. Thus, the objective of this review is to summarize the current evidence regarding the management of CAD in CKD patients, in particular with respect to uncertainties regarding coronary revascularization options, and their risk-benefit relationship in such a high-risk population.
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The impact of renal impairment on long-term safety and effectiveness of drug-eluting stents. PLoS One 2014; 9:e106450. [PMID: 25184244 PMCID: PMC4153613 DOI: 10.1371/journal.pone.0106450] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 08/08/2014] [Indexed: 11/19/2022] Open
Abstract
Background Renal impairment (RI) is associated with impaired prognosis in patients with coronary artery disease. Clinical and angiographic outcomes of patients undergoing percutaneous coronary intervention (PCI) with the use of drug-eluting stents (DES) in this patient population are not well established. Methods We pooled individual data for 5,011 patients from 3 trials with the exclusive and unrestricted use of DES (SIRTAX - N = 1,012, LEADERS - N = 1,707, RESOLUTE AC - N = 2,292). Angiographic follow-up was available for 1,544 lesions. Outcomes through 2 years were stratified according to glomerular filtration rate (normal renal function: GFR≥90 ml/min; mild RI: 90<GFR≥60 ml/min; moderate/severe RI GFR<60 ml/min). Results Patients with moderate/severe RI had an increased risk of cardiac death or myocardial infarction ([MI], OR 2.14, 95%CI 1.36–3.36), cardiac death (OR 2.21, 95%CI 1.10–4.46), and MI (OR 2.02, 95%CI 1.19–3.43) compared with patients with normal renal function at 2 years follow-up. There was no difference in cardiac death or MI between patients with mild RI compared to those with normal renal function (OR 1.10, 95%CI 0.75–1.61). The risk of target-lesion revascularization was similar for patients with moderate/severe RI (OR 1.17, 95%CI 0.70–1.95) and mild RI (OR 1.16, 95%CI 0.81–1.64) compared with patients with normal renal function. In-stent late loss and in-segment restenosis were not different for patients with moderate/severe RI, mild RI, and normal renal function. Conclusions Renal function does not affect clinical and angiographic effectiveness of DES. However, prognosis remains impaired among patients with moderate/severe RI.
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9
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An update on coronary artery disease and chronic kidney disease. Int J Nephrol 2014; 2014:767424. [PMID: 24734178 PMCID: PMC3964836 DOI: 10.1155/2014/767424] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/08/2014] [Accepted: 01/21/2014] [Indexed: 01/10/2023] Open
Abstract
Despite the improvements in diagnostic tools and medical applications, cardiovascular diseases (CVD), especially coronary artery disease (CAD), remain the most common cause of morbidity and mortality in patients with chronic kidney disease (CKD). The main factors for the heightened risk in this population, beside advanced age and a high proportion of diabetes and hypertension, are malnutrition, chronic inflammation, accelerated atherosclerosis, endothelial dysfunction, coronary artery calcification, left ventricular structural and functional abnormalities, and bone mineral disorders. Chronic kidney disease is now recognized as an independent risk factor for CAD. In community-based studies, decreased glomerular filtration rate (GFR) and proteinuria were both found to be independently associated with CAD. This paper will discuss classical and recent epidemiologic, pathophysiologic, and clinical aspects of CAD in CKD patients.
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10
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Comparison of modification of diet in renal disease and chronic kidney disease epidemiology collaboration formulas in predicting long-term outcomes in patients undergoing stent implantation due to stable coronary artery disease. Clin Res Cardiol 2014; 103:569-76. [PMID: 24609482 DOI: 10.1007/s00392-014-0687-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/12/2014] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The aim was to assess the predictive value of estimated glomerular filtration rate (eGFR) using two formulas: modification of diet in renal disease (MDRD) and chronic kidney disease epidemiology collaboration (CKD-EPI), in a population with stable coronary artery disease (SCAD) undergoing percutaneous coronary revascularization (PCI). METHODS The analyzed cohort included 3,141 consecutive patients with SCAD who underwent PCI, between January 2006 and December 2011. Follow-up data were available for 3,123 (99.4 %) patients. RESULTS The median follow-up was 1,127 days (interquartile range 566-1,634 days). During the observation period, 330 deaths were reported. In patients with serum creatinine (S-Cr) within normal range, eGFR by CKD-EPI equation predicted long-term outcome more accurately, than eGFR by MDRD formula-continuous Net Reclassification Improvement: 0.296 (95 % CI, 0.08-0.5 p = 0.03). In patients with elevated S-CR, eGFR calculated by both formulae had similar efficacy in assessing death risk. After adjustment for differences in clinical characteristics, both formulae were associated with mortality, but only in patients with elevated S-Cr: eGFR by MDRD (per 10 ml/min/1.73 m(2)) HR: 0.74 [95 % CI, 0.61-0.89, p = 0.002], eGFR by CKD-EPI (per 10 ml/min/1.73 m(2)) HR: 0.75 (95 % CI, 0.63-0.89, p = 0.001). After adjustment for covariates, eGFR by CKD-EPI equation did not offer more appropriate categorization of individuals with respect to long-term mortality. CONCLUSION Our results indicate that in multivariable analysis eGFR calculated by MDRD and CKD-EPI equations has similar predictive value. In a population of patients with SCAD and S-Cr within normal range, eGFR calculated by CKD-EPI equation outperforms eGFR calculated by MDRD equation in assessing death risk.
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Ahmed K, Jeong MH, Chakraborty R, Ahmed S, Hong YJ, Sim DS, Park KH, Kim JH, Ahn Y, Kang JC, Cho MC, Kim CJ, Kim YJ. Coronary Stents in Patients with ST-Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention. Korean Circ J 2012; 42:830-8. [PMID: 23323121 PMCID: PMC3539049 DOI: 10.4070/kcj.2012.42.12.830] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/04/2012] [Accepted: 08/05/2012] [Indexed: 12/05/2022] Open
Abstract
Background and Objectives Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). We sought to compare different coronary stents used during primary PCI in patients with ST-elevation myocardial infarction (STEMI) and CKD. Subjects and Methods We selected 2408 consecutive STEMI patients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) undergoing primary PCI and divided them into 5 groups based on the type of stent implanted: 1) bare metal stent (BMS), 2) paclitaxel-eluting stent (PES), 3) sirolimus-eluting stent (SES), 4) zotarolimus-eluting stent (ZES), or 5) everolimus-eluting stent (EES). The study endpoint was the number of major adverse cardiac events (MACE) at 12 months. Results There was no significant difference in the incidence of 12-month myocardial infarction, target lesion revascularization, or target vessel revascularization between stent groups; however, the overall rate of repeat revascularization differed significantly between groups. All-cause death differed significantly among the groups. The incidence of 12-month MACE in BMS, PES, SES, ZES, and EES was 8.3%, 9.8%, 8.6%, 5.5%, and 2.6%, respectively (p<0.001). Kaplan-Meier analysis did not show a significant differences in 12-month MACE-free survival among the groups (log-rank p=0.076). This finding remained the same after adjusting for multiple confounders (p=0.147). Conclusion Any of the 5 stents can be used to treat STEMI patients with CKD undergoing primary PCI; all have similar risk of 12-month MACE. This result is hypothesis-generating and warrants further evaluation with a long-term randomized study.
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Affiliation(s)
- Khurshid Ahmed
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea. ; Apollo Gleneagles Hospital, Kolkata, India
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Kaya E, Cuneo A, Hochadel M, Jünger C, Stepper W, Bramlage P, Kuck KH, Nienaber CA, Senges J, Eckardt L, Tebbe U, Reinecke H. Impact of chronic kidney disease on the prognosis of patients undergoing percutaneous coronary interventions using drug-eluting stents. Clin Res Cardiol 2011; 100:1103-9. [PMID: 21912915 DOI: 10.1007/s00392-011-0347-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 07/13/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) has an adverse impact on survival of patients with coronary artery disease and is associated with poor outcomes after percutaneous coronary intervention (PCI). Although small randomized, controlled clinical trials showed a reduced target vessel revascularization rate and a good safety profile for sirolimus-eluting coronary stents (SES), safety data need to be confirmed in clinical practice. Therefore, the data of the German DES.DE registry were evaluated to obtain acute and long-term data of this high-risk subgroup. METHODS The prospective multicenter German DES.DE registry enables to monitor the therapeutic outcome of different drug-eluting stents in the context of the German Health Care System. Baseline clinical and angiographic characteristics as well as one-year-follow-up data were recorded. From October 2005 to October 2006, 6,384 patients were enrolled at 98 DES.DE sites and stratified according to kidney disease progression: normal and impaired renal function and patients under chronic hemodialysis. RESULTS CKD was associated with several acute and chronic medical conditions and suffer from significantly more cardiac and cerebrovascular events after PCI as compared to patients without CKD. One-year-follow-up showed a significantly increased risk of restenosis and bleeding complications in patients with impaired renal function, especially in hemodialysis patients. CONCLUSIONS Impaired renal function in patients undergoing DES stenting carries an independent risk factor for restenosis and bleeding.
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Affiliation(s)
- Elif Kaya
- Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer Strasse 33, 48149, Münster, Germany.
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Bae EH, Lim SY, Choi YH, Suh SH, Cho KH, Choi JS, Kim CS, Park JW, Ma SK, Jeong MH, Kim SW, Korea Acute Myocardial Infarction Registry investigators. Drug-Eluting vs. Bare-Metal Stents for Treatment of Acute Myocardial Infarction With Renal Insufficiency. Circ J 2011; 75:2798-804. [DOI: 10.1253/circj.cj-11-0586] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School
| | - Sang Yup Lim
- Department of Internal Medicine, Korea University
| | - Young Hwan Choi
- Department of Internal Medicine, Chonnam National University Medical School
| | - Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School
| | - Kyung Hoon Cho
- Department of Internal Medicine, Chonnam National University Medical School
| | - Joon Seok Choi
- Department of Internal Medicine, Chonnam National University Medical School
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School
| | - Jeong Woo Park
- Department of Internal Medicine, Chonnam National University Medical School
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Medical School
- Cardiovascular Research Institute of Chonnam National University
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School
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El-Menyar AA, Al Suwaidi J, Holmes DR. Use of drug-eluting stents in patients with coronary artery disease and renal insufficiency. Mayo Clin Proc 2010; 85:165-71. [PMID: 20118392 PMCID: PMC2813825 DOI: 10.4065/mcp.2009.0314] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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 EBSCO 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.
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Affiliation(s)
| | | | - David R. Holmes
- Individual reprints of this article are not available. Address correspondence to David R. Holmes Jr, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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Charytan DM, Wallentin L, Lagerqvist B, Spacek R, De Winter RJ, Stern NM, Braunwald E, Cannon CP, Choudhry NK. Early angiography in patients with chronic kidney disease: a collaborative systematic review. Clin J Am Soc Nephrol 2009; 4:1032-43. [PMID: 19423566 DOI: 10.2215/cjn.05551008] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES In the general population, an early invasive strategy of routine coronary angiography is superior to a conservative strategy of selective angiography in patients who are admitted with unstable angina or non-ST segment elevation myocardial infarction (MI), but the effectiveness of this strategy in individuals with chronic kidney disease (CKD) is uncertain. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a collaborative meta-analysis with data provided by the main authors of identified trials to estimate the effectiveness of early angiography in patients with CKD. The Cochrane, Medline, and EMBASE databases were searched to identify randomized trials that compared invasive and conservative strategies in patients with unstable angina or non-ST MI. Pooled risks ratios were estimated using data from enrolled patients with estimated GFR <60 ml/min per 1.73 m(2). RESULTS Five randomized trials that enrolled 1453 patients with CKD were included. An early invasive strategy was associated with nonsignificant reductions in all-cause mortality, nonfatal MI, and a composite of death or nonfatal MI. The invasive strategy significantly reduced rehospitalization. CONCLUSIONS This collaborative study suggests that the benefits of an early invasive strategy are preserved in patients with CKD and that an early invasive approach reduces the risk for rehospitalization and is associated with trends of reduction in the risk for death and nonfatal re-infarction in patients with CKD. Coronary angiography should be considered for patients who have CKD and are admitted with non-ST elevation acute coronary syndromes.
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Affiliation(s)
- David M Charytan
- Renal Division and Clinical Biometrics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Na KY, Kim CW, Song YR, Chin HJ, Chae DW. The association between kidney function, coronary artery disease, and clinical outcome in patients undergoing coronary angiography. J Korean Med Sci 2009; 24 Suppl:S87-94. [PMID: 19194569 PMCID: PMC2633199 DOI: 10.3346/jkms.2009.24.s1.s87] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 11/11/2008] [Indexed: 01/09/2023] Open
Abstract
To characterize the association between chronic kidney disease (CKD), mortality, severity of coronary artery disease (CAD), treatment modality of CAD, and type of coronary stents among patients undergoing coronary angiography (CAG), we retrospectively reviewed the electronic medical records of the patients who underwent CAG at Seoul National University Bundang Hospital in Korea between May 2003 and January 2006. CKD was staged using an estimated glomerular filtration rate (eGFR) from the creatinine value prior to CAG. There were 3,637 patients included. The presence of CAD was 48% in CKD stage 1, 61% in stage 2, 73% in stage 3, 87% in stage 4, and 81% in stage 5. Survival rate gradually diminished for patients with decreasing renal function. No significant differences in all-cause and cardiac mortality were observed by medical treatment, PCI or CABG, in CKD patients with an eGFR less than 60 mL/min/1.73 m(2). CKD patients with drug-eluting stents showed significantly lower all-cause mortality (5.4% vs. 13.3%) and incidence of myocardial infarction (1.7% vs. 10%) than those with bare metal stents. In conclusion, an eGFR is a strong independent prognostic marker among patients undergoing CAG and the severity of CAD increases progressively with worsening renal function.
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Affiliation(s)
- Ki Young Na
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Weon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Rim Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Joon Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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