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Percutaneous transluminal coronary angioplasty in patients undergoing chronic dialysis
1Cardiology Unit, Medical Center Hospital of Vermont, University of Vermont, Burlington 05401.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) in chronic renal failure patients showed low success and high complication rates. Restenosis was also common, indicating high-risk outcomes for this population.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Limited data exists on percutaneous transluminal coronary angioplasty (PTCA) outcomes in patients with chronic renal failure (CRF).
- Patients with CRF undergoing chronic dialysis represent a unique and potentially high-risk group for cardiovascular interventions.
Purpose of the Study:
- To describe the short- and long-term results of PTCA in patients with CRF undergoing chronic dialysis.
- To evaluate the success, complication, and restenosis rates of PTCA in this specific patient population.
Main Methods:
- A cohort of seven patients with CRF on chronic dialysis underwent PTCA.
- Patients had complex coronary artery disease morphology (AHA/ACC Class B-1 or higher).
- Outcomes including procedural success, complications, and restenosis were assessed during follow-up.
Main Results:
- PTCA was successful in 57% of patients (4/7), with a 29% complication rate (2/7), including one death.
- Among initially successful PTCA cases, two out of three surviving patients developed restenosis within a mean follow-up of 6 months.
- Patients with unsuccessful PTCA required bypass surgery, with one late death.
Conclusions:
- Patients with chronic renal failure undergoing PTCA represent a high-risk group.
- PTCA in this population is associated with reduced success rates, increased complications, and a high incidence of restenosis.
- Alternative revascularization strategies or careful patient selection may be warranted for CRF patients requiring coronary intervention.
Abstract:
Very limited data on percutaneous transluminal coronary angioplasty in patients with chronic renal failure is available. We describe the short- and long-term results of percutaneous transluminal coronary angioplasty (PTCA) in a group of seven patients undergoing chronic dialysis. Percutaneous transluminal coronary angioplasty was undertaken because of poorly controlled symptoms in five patients and reversible defects on thallium scintigraphy prior to major surgery in two patients. There were five men and two women, the mean age was 51 years (range 36-75). Six patients were on hemodialysis and one was receiving peritoneal dialysis. All seven patients had complicated baseline coronary stenosis morphology ( greater than or equal to AHA/ACC Class B-1). Percutaneous transluminal coronary angioplasty was successful in four patients (57%) and associated with complications in two patients (29%) including one death. Surviving patients were followed for a mean of 6 months (range 3-23 months). Of three surviving patients with initially successful PTCA, two developed restenosis. All three patients with unsuccessful PTCA underwent bypass surgery with one late death. Patients with chronic renal failure compose a high risk population for PTCA with a reduced success rate, an increased complication rate, and a high restenosis rate.