Aortic valvular calcification predicts restenosis after implantation of drug-eluting stents in patients on chronic haemodialysis.
BACKGROUND
Even in the drug-eluting stent (DES) era, the restenosis rate of the follow-up period after percutaneous coronary intervention (PCI) is higher in haemodialysis (HD) patients than in non-HD patients. Therefore, higher restenosis remains a clinical limitation in HD patients, and a simple clinical method to predict patients likely to have restenosis after stent implantation is attractive. The present study investigated the potential relationship between aortic valvular calcification (AVC) and angiographical restenosis at follow-up after DES implantation in patients on maintenance HD.


METHODS
In the study, 97 patients were enrolled. We prospectively performed echocardiography before elective PCI with DES implantation. Angiographic follow-up was scheduled between 6 and 8 months after PCI. Restenosis at follow-up was defined as a diameter stenosis of > or =50% by measuring quantitative coronary angiography.


RESULTS
Of the enrolled patients, 59 patients (60.8%) had AVC. Complete angiographical follow-up was obtained in 86 patients (88.7%). The angiographical restenosis rate during the follow-up period was 24.7% in patients with AVC and 8.9% in patients without AVC [hazard ratio (HR) 3.36; 95% confidence interval (CI) 1.18-9.56, P = 0.023]. Even after multivariate adjustment including covariates related to atherogenecity, AVC remained an independent predictor of restenosis after implanting DES (HR 3.83; 95% CI 1.14-12.9, P = 0.029). Late lumen loss suggesting neointimal growth after DES implantation was 0.28 +/- 0.70 mm in the non-AVC group and 0.64 +/- 0.90 mm in the AVC group (P = 0.013).


CONCLUSIONS
AVC provides predictive information regarding DES implantation in patients on maintenance HD.
Ishii
Hideki
H
Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. hkishii@med.nagoya-u.ac.jp
Kumada
Yoshitake
Y
Toriyama
Takanobu
T
Aoyama
Toru
T
Takahashi
Hiroshi
H
Amano
Tetsuya
T
Yasuda
Yoshinari
Y
Yuzawa
Yukio
Y
Maruyama
Syoichi
S
Matsuo
Seiichi
S
Matsubara
Tatsuaki
T
Murohara
Toyoaki
T
D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging; D009202:Cardiomyopathies / Q000150:complications* / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D054855:Drug-Eluting Stents; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012307:Risk Factors