Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation.

Abstract

Accelerated atherosclerosis in prolonged maintenance hemodialysis (HD) has been recognized; however, whether HD duration is associated with poor clinical outcome in HD patients with coronary artery disease (CAD) after drug-eluting stent (DES) implantation is unknown. We evaluated the impact of HD duration on clinical outcomes in HD patients with CAD after DES implantation. Between April 2007 and December 2012, 168 angina pectoris patients (320 de novo lesions) on HD were treated with DES. Major adverse cardiovascular events (MACE) and target lesion revascularization (TLR) were investigated at 3 years according to the HD duration (≤ 3 years, 83 patients; >3 years, 85 patients). The incidence of MACE was significantly higher in the long HD duration group (25.3 vs. 50.6 %; P = 0.001). Especially, sudden cardiac death (SCD) was significantly higher in the long HD duration group (3.6 vs. 16.5 %; P = 0.006). On the other hand, the rates of TLR were similar between the two groups (12.0 vs. 14.1 %; P = 0.69). Cox's proportional hazard analysis revealed that HD duration (HR 1.08 per year, 95 % CI 1.03-1.13, P = 0.002), β-blocker use (0.28, 0.17-0.46, P < 0.001), and diabetes mellitus (2.10, 1.23-3.56, P = 0.007) were independent predictors of MACE. Longer HD duration did not affect TLR; however, SCD was significantly higher in the long HD duration group.

• Authors: Norihiro Kobayashi, Toshiya Muramatsu, Reiko Tsukahara, Yoshiaki Ito, Hiroshi Ishimori, Keisuke Hirano, Masatsugu Nakano, Masahiro Yamawaki, Motoharu Araki, Hideyuki Takimura, Yasunari Sakamoto
• Journal: Heart and vessels (Heart Vessels) Vol. 31 Issue 3 Pg. 330-40 (Mar 2016) ISSN: 1615-2573 [Electronic] Japan
• PMID: 25523891 (Publication Type: Journal Article)

Topics

• Aged
• Angioplasty, Balloon, Coronary (adverse effects, instrumentation, mortality)
• Coronary Angiography
• Coronary Artery Disease (complications, diagnostic imaging, mortality, therapy)
• Death, Sudden, Cardiac (etiology)
• Female
• Humans
• Kaplan-Meier Estimate
• Kidney Diseases (complications, diagnosis, mortality, therapy)
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (etiology)
• Proportional Hazards Models
• Renal Dialysis (adverse effects)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stents
• Time Factors
• Treatment Outcome