title: Treatment of symptomatic coronary artery disease in patients with end-stage renal disease on hemodialysis with paclitaxel-eluting TAXUS stent.
abstract: Percutaneous coronary intervention (PCI) utilizing drug-eluting stents is becoming a very common revascularization technique in the dialysis cohort; therefore, we sought to identify the impact of dialysis on outcomes in this group of patients. This is a multicenter registry comparing results of 290 patients (186 with normal kidney function, 104 on dialysis) who underwent PCI with exclusive use of paclitaxel-eluting TAXUS stent. The primary endpoint was an assessment of major adverse cardiac events (MACE) at 1- and 2-year observation. Mean follow-up was 23.3 ± 6.1 months. Results at 12 months showed: MACE 11.8% vs. 7.7% (P = not significant [ns]), composite major adverse cardiac and cerebrovascular events (MACCE) 12.4% vs. 11.5% (P = ns), all-cause death 2.7% vs. 8.6% (P < 0.05), cardiac death 2.7% vs. 1.9% (P = ns), target vessel revascularization (TVR) 9.1% vs. 6.7% (P = ns), acute myocardial infarction (AMI) 3.8% vs. 2.9% (P = ns), cerebrovascular events (CVA) 0.5% vs. 1.0% (P = ns); and results at 24 months showed: MACE 17.7% vs. 18.3% (P = ns), MACCE 21.5% vs. 26.0% (P = ns), all-cause death 4.3% vs. 14.4% (P < 0.01), cardiac death 3.2% vs. 1.9% (P = ns), TVR 14.0% vs. 16.3% (P = ns), AMI 5.4% vs. 5.8% (P = ns), CVA 3.2% vs. 2.9% (P = ns) for non-end-stage renal disease (ESRD) and dialysis group, respectively. Prior coronary artery bypass graft (CABG) was found to be single risk factor for MACE, TVR, and MACCE in patients with ESRD, while dialysis and prior CABG were found to be single risk factors for death in the entire population. PCI with TAXUS is a feasible procedure and presents promising results in dialysis-dependent patients.
authors.affiliation: San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.|Norwalk Hospital, Yale School of Medicine, Norwalk, Connecticut, USA.
authors.forename: Szymon L
authors.initials: SL
authors.lastname: Wiernek
authors.affiliation: San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.|University of Texas Health Science Center, San Antonio, Texas, USA.
authors.forename: R Stefan
authors.initials: RS
authors.lastname: Kiesz
authors.affiliation: San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.|Medical University of Silesia, Katowice, Poland.
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Wiernek
authors.affiliation: American Heart of Poland, Katowice, Poland.|Medical University of Silesia, Zabrze, Poland.
authors.forename: Piotr P
authors.initials: PP
authors.lastname: Buszman
authors.affiliation: San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.|American Heart of Poland, Katowice, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Janas
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Jack L
authors.initials: JL
authors.lastname: Martin
authors.affiliation: American Heart of Poland, Katowice, Poland.
authors.forename: Blazej
authors.initials: B
authors.lastname: Trela
authors.affiliation: University of Texas Health Science Center, San Antonio, Texas, USA.|Kidney Specialists, San Antonio, Texas, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Szewc
authors.affiliation: Medical University of Silesia, Katowice, Poland.|American Heart of Poland, Katowice, Poland.
authors.forename: Pawel E
authors.initials: PE
authors.lastname: Buszman
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel
keywords: End-stage renal disease; dialysis; drug-eluting stents; paclitaxel; percutaneous coronary intervention