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Coronary calcification and cardiac events after percutaneous intervention in dialysis patients
D L Bonifacio1, K Malineni, R A Kadakia
1Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
Insights
Coronary calcification in dialysis patients undergoing percutaneous coronary intervention is linked to lower cholesterol levels. This finding suggests potentially favorable outcomes despite the presence of vascular calcification.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Renal dialysis patients exhibit increased vascular calcification.
- The clinical impact of coronary calcification on percutaneous coronary intervention (PCI) outcomes in dialysis patients remains unclear.
Purpose of the Study:
- To investigate the association between coronary calcification and cardiovascular outcomes in dialysis patients undergoing PCI.
- To explore the relationship between coronary calcification, lipid profiles, and interventional success in this patient group.
Main Methods:
- A prospective interventional database analysis of 41 dialysis patients who underwent coronary angioplasty.
- Review of angiograms for coronary calcification in target and reference vessels.
- Comparison of baseline clinical factors, lipid profiles, and cardiovascular outcomes between patients with and without calcification.
Main Results:
- Patients with coronary calcification had significantly lower total cholesterol (P=0.02).
- The composite endpoint of target vessel revascularization, myocardial infarction, or death was less frequent in patients with coronary calcification (47.4% vs 77.3%, P=0.06).
- Fluoroscopically identified coronary calcification was associated with significantly improved event-free survival (P=0.05) after adjusting for years on dialysis.
Conclusions:
- Coronary calcification in dialysis patients undergoing PCI is associated with lower total cholesterol.
- The presence of coronary calcification may indicate more favorable interventional outcomes in this high-risk population.
Background:
Previous studies have described increased vascular calcification in renal dialysis patients. The clinical significance of this finding with respect to outcomes after percutaneous coronary intervention in this population is unknown.
Methods:
We analysed a prospective interventional database at a single tertiary center and identified 41 dialysis patients who underwent coronary angioplasty. All studies were reviewed for the presence of coronary calcium in the target and reference vessels and compared with respect to baseline clinical factors and cardiovascular outcomes.
Results:
The mean ages for those with and without coronary calcification were 63.6 +/- 11.0 and 67.3 +/- 11.0, respectively, P = 0.30. The groups were similar in years on dialysis, diabetes, hypertension, smoking, and measures of calcium and phosphate balance. The total cholesterol, LDL-C, HDL-C, and triglycerides were 162.5 +/- 42.3 and 202.0 +/- 54.5, P = 0.02; 94.9 +/- 39.6 and 121.2 +/- 48.1, P = 0.18; 39.3 +/- 12.4 and 47.3 +/- 12.2, P = 0.15; 157.4 +/- 100.4 and 181.3 +/- 187.4, P = 0.15, for those with and without calcification, respectively. The composite of target vessel revascularization, myocardial infarction, or death was 47.4% and 77.3% for those with and without calcification, respectively, P = 0.06. The Cox proportional hazards model, controlling for years on dialysis, showed a significant, event-free survival in those with coronary calcium seen fluoroscopically, P = 0.05.
Conclusions:
In dialysis patients, coronary calcification identified in the target or reference vessels is associated with lower total cholesterol and favourable interventional outcomes.