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Outcome of dialysis patients submitted to coronary revascularization
C Rollino1, M Formica, M Minelli
1Department of Nephrology and Cardiology, Giovanni Bosco Hospital, Turin, Italy.
Insights
Coronary revascularization in dialysis patients is a high-risk procedure with significant mortality. Early screening and intervention for coronary artery disease (CAD) in these patients may improve outcomes.
Area of Science:
- Nephrology
- Cardiology
- Vascular Medicine
Background:
- Cardiovascular disease is the leading cause of mortality in end-stage renal disease (ESRD) patients.
- The efficacy and safety of coronary revascularization in ESRD patients remain debated.
- Dialysis patients often present with diffuse vasculopathy and severe comorbidities.
Purpose of the Study:
- To evaluate the risks and outcomes of coronary revascularization in patients with end-stage renal disease.
- To compare outcomes between percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG).
- To assess the impact of diabetes on revascularization outcomes in dialysis patients.
Main Methods:
- Retrospective analysis of 17 dialysis patients who underwent coronary revascularization (PTCA or CABG) between 1991 and the study period.
- Data collected included patient demographics, dialysis modality, procedure type, coronary lesion characteristics, comorbidities, and survival.
- Survival analysis was performed to assess outcomes at various time points.
Main Results:
- Coronary revascularization was technically successful in all patients.
- Mean survival was 25.09 months, with 47% survival at 2 years.
- Mortality was high, with 12 out of 17 patients dying, 5 within the first month.
- No significant difference in outcomes was observed between PTCA and CABG, or between diabetic and non-diabetic patients.
Conclusions:
- Coronary revascularization in dialysis patients is associated with high procedural risk and mortality.
- Severe patient condition, diffuse vasculopathy, and delayed intervention contribute to poor outcomes.
- Earlier screening for coronary artery disease and timely revascularization are suggested for dialysis patients.
Abstract:
Cardiovascular disease accounts for almost half of the total mortality in patients with end stage renal disease (ESRD). It has recently been debated whether coronary revascularization has the same rate of risks and successes in this cohort of patients compared to patients without renal disease. Since 1991, 17 dialysis patients were submitted to coronary revascularization in our center. Seven patients were following peritoneal, 10 hemodialytic treatment. Four patients were submitted to percutaneous transluminal coronary angioplasty (PTCA) and 13 to surgical revascularization (CABG). In 2 patients the coronary lesion was unique, in the others stenosis of multiple vessels were found. Six patients were diabetic. The mean age at the onset of the coronary artery disease (CAD) was 57.17 +/- 11.6 years. The mean time elapsed from the onset of the CAD and the performance of the PTCA or CABG was 30.1 +/- 35.4 months. The mean time from beginning of dialysis treatment to revascularization was 48.2 +/- 39.6 months. Mean hemoglobin values were 9.7 +/- 1 g/dL, mean phosphorus values were 5.2 +/- 8.7 mg/dL, mean cholesterol values were 211 +/- 49.5 mg/dL. The procedure was technically successful in all patients. Mean survival was 25.09 +/- 28.12 months. Twelve patients died, 5 of whom within one month. Survival at one month was 70.5%, at 6 months 58.8%, at one year 52.9%, at 2 years 47%. There was neither significant difference patients submitted to PTCA and those submitted to CABG, nor between diabetic and non-diabetic patients. In conclusion, coronary revascularization in our experience is a high risk procedure in dialysis patients. The reasons for this could be the severe general conditions of these patients affected with diffuse vasculopathy and the long time elapsed since the onset of the ischemic cardiopathy. Thus, our results could suggest the opportunity of performing earlier screening of coronary situation and revascularization treatment in CAD dialysis patients.