title: Impact of hemodialysis on local vessel healing and thrombus formation after drug-eluting stent implantation.
abstract: BACKGROUND
  Although hemodialysis (HD) is a suggested risk factor for stent thrombosis, its contribution to local vessel healing after drug-eluting stent (DES) implantation is unclear.
  
  
  METHODS
  A total of 121 patients (152 lesions treated with DES) who underwent 8-month follow-up coronary angiography with optical coherence tomography (OCT) were enrolled, and the findings were compared between patients with and without HD. To match baseline differences, mid-term OCT findings of 42 propensity score-matched lesions (21 non-HD vs. 21 HD) were compared. Effects of HD on the efficacy of antiplatelet therapy were also evaluated by VerifyNow assay (Accumetrics, San Diego, CA, USA).
  
  
  RESULTS
  Patients with HD had a significantly higher rate of thrombus formation than those without (64% vs. 33%, p = 0.007), although the baseline parameters and lesion characteristics differed between the groups. Multivariate logistic regression analysis revealed that HD was associated with an increased risk of thrombus formation (odds ratio 5.991, 95% confidence interval: 1.972-18.199, p = 0.002). Even after propensity-matching for patient background and balancing of angiographic and OCT variables, the risk of thrombus formation remained significantly higher in HD patients. The P2Y12-reaction unit was significantly increased after HD (Pre HD: 211 ± 75 vs. Post HD: 262 ± 59, p = 0.01), but patients without HD showed no increase during the same elapsed time (221 ± 88 vs. 212 ± 96, p = 0.19).
  
  
  CONCLUSIONS
  HD is a potential risk factor for subclinical thrombus attachment after DES therapy. Systemic problems, such as residual platelet reactivity, associated with HD as well as local vessel features in HD patients might contribute to the increased incidence of thrombus attachment and subsequent onset of thrombotic event after DES implantation.
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Konishi
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan. Electronic address: shinke@med.kobe-u.ac.jp.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.affiliation: Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Daisaku
authors.initials: D
authors.lastname: Nakatani
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hariki
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Osue
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Taniguchi
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Nishio
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Hiranuma
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kinutani
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kuroda
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Shite
authors.affiliation: Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D041623:Tomography, Optical Coherence
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Drug-eluting stents; Hemodialysis; Thrombus