title: Impact of chronic kidney disease on a re-percutaneous coronary intervention for sirolimus-eluting stent restenosis.
abstract: OBJECTIVE
  Recurrent in-stent restenosis remains an important clinical issue after a percutaneous coronary intervention even after treatment with a sirolimus-eluting stent (SES) especially in patients with chronic kidney disease. We evaluated the impact of renal insufficiency on the clinical and angiographic outcomes after treatment for SES restenosis.
  
  
  RESULTS
  A total of 74 patients with 76 lesions underwent subsequent revascularization with a drug-eluting stent for SES restenosis. Patients were classified into three groups: group 1 included 29 patients with an estimated glomerular filtration rate more than 60 ml/min/1.73 m(2); group 2 included 27 patients with lower estimated glomerular filtration rate (<60 ml/min/1.73 m(2)) without hemodialysis (HD) dependence; and group 3 included 18 patients on HD. Clinical and angiographic follow-up was carried out at 8 months. Late lumen loss at the 8-month follow-up angiography showed progressive increases from group 1 to 2 to 3 (group 1: 0.36 ± 0.39 mm, group 2: 1.11 ± 0.61 mm, group 3: 1.30 ± 0.85 mm, P<0.001). Similarly, compared with group 1, groups 2 and 3 had significantly higher rates of major adverse cardiac events (6.9, 37.0, and 38.9%, respectively, P=0.001), primarily because of a high frequency of target lesion revascularization (8.0, 34.8, and 33.3%, respectively, P=0.019).
  
  
  CONCLUSIONS
  Non-HD-dependent chronic kidney disease patients had increased neointimal growth in the follow-up phase after percutaneous coronary intervention, with a drug-eluting stent for SES restenosis almost equivalent to patients on HD, resulting in higher rates of recurrent restenosis than patients with preserved renal function.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Aoyama
authors.forename: Haruo
authors.initials: H
authors.lastname: Hirayama
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.forename: Koichi
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Kiyotake
authors.initials: K
authors.lastname: Ishikawa
authors.forename: Masateru
authors.initials: M
authors.lastname: Takigawa
authors.forename: Mamoru
authors.initials: M
authors.lastname: Nanasato
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.forename: Daiji
authors.initials: D
authors.lastname: Yoshikawa
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Matsubara
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011475:Prosthesis Failure; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000494:pharmacology*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus