Distribution of coronary artery disease and relation to mortality in asymptomatic hemodialysis patients.
BACKGROUND
Long-term dialysis patients have a high incidence of myocardial infarction and cardiovascular death, but the incidence of coronary artery disease (CAD) in asymptomatic patients, distribution of coronary obstruction, and relationship between lesion location and mortality are unknown.


METHODS
We studied 67 asymptomatic hemodialysis patients who volunteered for coronary angiography. Coronary stenoses of 50% or greater were documented, and the location of each within the proximal, midportion, or distal segment of the coronary vessel was recorded. Patients were followed up until death or renal transplantation. Cox proportional hazards regression was performed to analyze the relationship of lesion location with mortality.


RESULTS
Obstructive CAD was common. Twenty-eight subjects (41.7%) had 50% or greater stenosis in at least 1 epicardial vessel, and 19 subjects (28.5%) had evidence of CAD within the proximal third of an epicardial vessel. After a median follow-up of 2.7 years, the presence of proximal CAD was associated with a marked increase in risk of death (adjusted hazard ratio, 3.14; 95% confidence interval, 1.34 to 7.33; P = 0.008) and was associated more strongly with mortality than multivessel disease or left anterior descending disease.


CONCLUSIONS
CAD is common in asymptomatic dialysis patients, and stenoses frequently are located within the proximal coronary arteries, where they are associated with markedly increased risks of death. Additional studies are needed to determine whether proximal disease is a modifiable risk factor for cardiovascular mortality in dialysis patients.
Charytan
David
D
Renal Division, Center for Clinical Biometrics, Brigham and Women's Hospital, Boston, MA 02120, USA. dcharytan@partners.org
Kuntz
Richard E
RE
Mauri
Laura
L
DeFilippi
Christopher
C
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000401:mortality* / Q000473:pathology*; D023921:Coronary Stenosis / Q000401:mortality / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate