Comparison of percutaneous coronary intervention with medication in the treatment of coronary artery disease in hemodialysis patients.
It has been reported that percutaneous coronary intervention (PCI) is beneficial for coronary artery disease (CAD) among the general population. However, its effects in patients who are on hemodialysis (HD) remain unclear. A prospective cohort study was performed to clarify whether PCI has a therapeutic advantage over medical therapy among HD patients with CAD. A follow-up study to 5 yr was conducted among 259 HD patients with ischemic heart disease. Mean follow-up was 39 mo. Patients were divided into three groups: 122 patients without significant stenosis, 88 patients who had significant stenosis and were treated with PCI, and 49 patients who had significant stenosis and were treated with medication only. The primary end point was cardiac death, and the secondary end point was all-cause death. The results showed that the 5-yr cardiac survival rate was 41.6% in the medication group, 77.1% in the PCI group (P = 0.0006), and 84.5% in the nonstenosis group (P < 0.0001). The 5-yr all-cause survival rate was 19.3% in the medication group, 48.4% in the PCI group (P = 0.004), and 64.3% in the nonstenosis group (P < 0.0001). Even after adjustment for other risk factors, effects of PCI on the risk for cardiac and all-cause death remained significant and independent (odds ratio 0.14; 95% confidence interval 0.08 to 0.25, P = 0.0006; and odds ratio 0.37; 95% confidence interval 0.26 to 0.54, P = 0.0062, respectively). Results were consistent when the therapeutic effect of PCI or medication was analyzed using propensity-matched patients. These data suggested that PCI could improve the prognosis of HD patients with CAD. PCI would be recommended for HD patients with CAD.
Yasuda
Kaoru
K
Department of Nephrology, Nagoya Kyoritsu Hospital, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kasuga
Hirotake
H
Aoyama
Toru
T
Takahashi
Hiroshi
H
Toriyama
Takanobu
T
Kawade
Yasumasa
Y
Iwashima
Shigejiro
S
Yamada
Shigeki
S
Kawahara
Hirohisa
H
Maruyama
Shoichi
S
Yuzawa
Yukio
Y
Ishii
Hideki
H
Murohara
Toyoaki
T
Matsuo
Seiichi
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D023921:Coronary Stenosis / Q000628:therapy; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents