[The role of reduction of glomerular filtration rate in outcomes of drug-eluting stents implantation in patients with ischemic heart disease and chronic kidney disease].
Patients (n=432) subjected to percutaneous coronary interventions (PCI) with implantation of one or more drug eluting stents (DES) in 2005 were included in this study. These patients were divided into 3 groups according to baseline glomerular filtration rate (GFR): group 1 - GFR 60 ml/min/1.73 m2, n=271, group 2 - GFR 30-60 ml/min/1.73 m2, n=132, group 3 - GFR <30 ml/min/1.73 m2, n=29. In all patients only contrast preparation iodixanol was used and prevention of contrast induced nephropathy (CIN) was implemented. Immediate success of PCI was higher and comparable between groups. Rate of development of CIN turned out significantly higher in groups 2 and 3 (6.8 and 17.2% compared with 0.7% in group 1, <0.001). During 12 months of follow up restenosis rate was higher in groups 2 and 3 (15.9 and 27.6% compared with 6.6% in group 1, <0.001). Lowered GFR became predictor of long term (up to 3 years) mortality in patients with CKD as for group 2 compared with group 1 relative risk (RR) of death was 1.77 (95%CI 1.19-3.74, =0.001), and for group 3 compared with group 1 - 3.69 (95%CI 1.58-6.87), =0.001. In addition lowered GFR was predictor of nonfatal myocardial infarction (MI) up to 3 years: for group 2 compared with group 1 RR 1.69 95%CI 1.12-3.07, =0.009, for group 3 compared with group 1 RR 3.44 95%CI 1.37-6.19, =0.001. The conducted study showed that initially lowered GFR after stenting increased risk of development of CIN, led to rise of restenosis rate and repeat revascularizations up to 12 months, and also appears to be predictor of death and nonfatal MI in remote period up to 3 years.
Shul'zhenko
L V
LV
Sani Konukoglu Medical Center, Gaziantep, Turkey; Moscow, Presidential Medical Center of Russia, ul. Marshala Timoshenko 15, 121356 Moscow, Russia.
Pershukov
I V
IV
Batyraliev
T A
TA
Fettser
D V
DV
Sidorenko
B A
BA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects; D054855:Drug-Eluting Stents; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014283:Triiodobenzoic Acids / Q000009:adverse effects; D014421:Turkey / Q000453:epidemiology
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol