title: Aortic valvular calcification predicts restenosis after implantation of drug-eluting stents in patients on chronic haemodialysis.
abstract: 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.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. hkishii@med.nagoya-u.ac.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.forename: Yoshitake
authors.initials: Y
authors.lastname: Kumada
authors.forename: Takanobu
authors.initials: T
authors.lastname: Toriyama
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Amano
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Yasuda
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
authors.forename: Syoichi
authors.initials: S
authors.lastname: Maruyama
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Matsubara
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: 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