Treatment of Coronary Artery Disease in Dialysis Patients
Treatment of Coronary Artery Disease in Dialysis Patients
From April 16, 2002 to October 16, 2002, 10 consecutive patients with coronary disease on chronic dialysis were treated with sirolimus-eluting stents. Diabetes was present in 30% and half of the patients had multivessel coronary disease. On average, patients had been on dialysis for 5 years prior to the procedure (range: 215 years). Five patients were on hemodialysis and 5 patients were on peritoneal dialysis. Overall, 18 lesions were treated with 1.9 ± 1.1 sirolimus-eluting stents per patient. At a mean follow-up of 403 days, there were no cases of death, myocardial infarction, or target lesion revascularization.
In this preliminary series, sirolimus-eluting stent implantation appeared safe and effective for the treatment of dialysis patients with coronary artery disease. Dialysis patients are well known to be a high-risk population for cardiovascular morbidity and mortality, especially due to coronary atherosclerotic disease. However, the management of coronary disease in patients with end-stage renal failure is often problematic due to the presence of multiple co-morbidities and frequent limitations to drug prescription. Moreover, these patients have been reported to be at a higher risk for short- and long-term complications after invasive treatment compared to non-dialysis patients.
The overall impact of invasive coronary treatment in dialysis patients is an ongoing debate. In a recent report, coronary bypass surgery was associated with superior outcomes compared to conventional stenting, with in-stent restenosis being suggested as a possible contributor to the impaired outcomes after percutaneous treatment.
Sirolimus-eluting stents (SES) have been recently shown in randomized studies to markedly decrease neointimal growth and in-stent restenosis in comparison with conventional stents. However, all clinical trials conducted to date excluded patients with decreased renal function, and therefore the impact of SES implantation in patients with renal failure is currently unknown. The present study aimed to report on the 1-year clinical outcomes of a consecutive series of patients on chronic dialysis treated with SES.
Since April 2002, SES (Cypher; Johnson & Johnson-Cordis unit, Cordis Europa NV, Roden, the Netherlands) have been routinely utilized as the device of choice for all patients treated with percutaneous coronary intervention in our institution.8 During the first 6 months of this policy, SES implantation was performed in ten consecutive patients on chronic dialysis, who comprise the present study population. All patients on either chronic haemodialysis or peritoneal dialysis at the time of the procedure were included.
From April 16, 2002 to October 16, 2002, 10 consecutive patients with coronary disease on chronic dialysis were treated with sirolimus-eluting stents. Diabetes was present in 30% and half of the patients had multivessel coronary disease. On average, patients had been on dialysis for 5 years prior to the procedure (range: 215 years). Five patients were on hemodialysis and 5 patients were on peritoneal dialysis. Overall, 18 lesions were treated with 1.9 ± 1.1 sirolimus-eluting stents per patient. At a mean follow-up of 403 days, there were no cases of death, myocardial infarction, or target lesion revascularization.
In this preliminary series, sirolimus-eluting stent implantation appeared safe and effective for the treatment of dialysis patients with coronary artery disease. Dialysis patients are well known to be a high-risk population for cardiovascular morbidity and mortality, especially due to coronary atherosclerotic disease. However, the management of coronary disease in patients with end-stage renal failure is often problematic due to the presence of multiple co-morbidities and frequent limitations to drug prescription. Moreover, these patients have been reported to be at a higher risk for short- and long-term complications after invasive treatment compared to non-dialysis patients.
The overall impact of invasive coronary treatment in dialysis patients is an ongoing debate. In a recent report, coronary bypass surgery was associated with superior outcomes compared to conventional stenting, with in-stent restenosis being suggested as a possible contributor to the impaired outcomes after percutaneous treatment.
Sirolimus-eluting stents (SES) have been recently shown in randomized studies to markedly decrease neointimal growth and in-stent restenosis in comparison with conventional stents. However, all clinical trials conducted to date excluded patients with decreased renal function, and therefore the impact of SES implantation in patients with renal failure is currently unknown. The present study aimed to report on the 1-year clinical outcomes of a consecutive series of patients on chronic dialysis treated with SES.
Since April 2002, SES (Cypher; Johnson & Johnson-Cordis unit, Cordis Europa NV, Roden, the Netherlands) have been routinely utilized as the device of choice for all patients treated with percutaneous coronary intervention in our institution.8 During the first 6 months of this policy, SES implantation was performed in ten consecutive patients on chronic dialysis, who comprise the present study population. All patients on either chronic haemodialysis or peritoneal dialysis at the time of the procedure were included.
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