Treatment of coronary artery disease in hemodialysis patients evaluated for transplant-a registry study.
BACKGROUND
We assessed the results of a noninvasive therapeutic strategy on the long-term occurrence of cardiac events and death in a registry of patients with chronic kidney disease (CKD) and coronary artery disease (CAD).


METHODS
We analyzed 519 patients with CKD (56+/-9 years, 67% men, 67% whites) on maintenance hemodialysis with clinical or scintigraphic evidence of CAD by using coronary angiography.


RESULTS
In 230 (44%) patients, coronary angiography revealed significant CAD (lumen reduction > or =70%). Subjects with significant CAD were kept on medical treatment (MT; n=184) or referred for myocardial revascularization (percutaneous transluminal coronary angioplasty/coronary artery bypass graft-intervention; n=30) according to American College of Cardiology/American Heart Association guidelines. In addition, 16 subjects refused intervention and were also followed-up. Event-free survival for patients on MT at 12, 36, and 60 months was 86%, 71%, and 57%, whereas overall survival was 89%, 71%, and 50% in the same period, respectively. Patients who refused intervention had a significantly worse prognosis compared with those who actually underwent intervention (events: hazard ratio=4.50; % confidence interval=1.48-15.10; death: hazard ratio=3.39; % confidence interval 1.41-8.45).


CONCLUSIONS
In patients with CKD and significant CAD, MT promotes adequate long-term event-free survival. However, failure to perform a coronary intervention when necessary results in an accentuated increased risk of events and death.
De Lima
José Jayme G
JJ
Heart Institute (InCor), Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil. jose.lima@incor.usp.br
Gowdak
Luís Henrique W
LH
de Paula
Flávio Jota
FJ
Arantes
Rodolfo L
RL
de Oliveira
André Luís Veiga
AL
Ramires
Jose Antonio F
JA
César
Luiz Antonio M
LA
Krieger
Eduardo M
EM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001938:Brazil / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016312:Treatment Refusal; D014850:Waiting Lists
D002317:Cardiovascular Agents