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Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
Long-term cardiovascular prognosis after rotational atherectomy in hemodialysis patients: Data from the J2T
Kentaro Jujo1, Hisao Otsuki1, Kazuki Tanaka1
1Department of Cardiology, Tokyo Women's Medical University, Japan.
Insights
Optimal medication and successful rotational atherectomy (RA) with final thrombolysis in myocardial infarction (TIMI) 3 flow improve cardiovascular (CV) survival in hemodialysis (HD) patients undergoing percutaneous coronary intervention (PCI). These strategies are key for better long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nephrology
Background:
- Patients on hemodialysis (HD) exhibit severe coronary artery calcification, leading to poorer outcomes after percutaneous coronary intervention (PCI).
- Rotational atherectomy (RA) is crucial for managing heavily calcified lesions during PCI.
Purpose of the Study:
- To identify clinical and procedural factors predicting long-term outcomes in HD patients undergoing PCI with RA in the drug-eluting stent (DES) era.
- To establish therapeutic strategies for improving cardiovascular (CV) mortality in this high-risk population.
Main Methods:
- A multicenter registry study included 302 HD patients who underwent RA for de novo calcified lesions.
- The primary endpoint was 5-year cardiovascular (CV) death.
Main Results:
- Cardiovascular (CV) death occurred in 19.5% of patients over 5 years.
- Factors associated with better CV outcomes included larger RA burr size, achievement of final thrombolysis in myocardial infarction (TIMI) 3 flow, lower brain natriuretic peptide (BNP) levels, and optimal medication use.
- Lower left ventricular ejection fraction, higher BNP, and lower rates of RA burr upsizing and final TIMI 3 flow were observed in the CV death group.
Conclusions:
- In the DES era, specific oral medications and stepwise calcium ablation during PCI with RA are linked to improved long-term CV survival in HD patients.
- These findings highlight the importance of tailored therapeutic strategies for managing complex coronary stenoses in HD patients.
Background:
Hemodialysis (HD) patients have heavy calcium deposits in their stenotic coronary arteries and worse post-percutaneous coronary intervention (PCI) prognoses than those who do not undergo HD. Rotational atherectomy (RA) facilitates PCI success in severely calcified lesions. We aimed to identify clinical and procedural characteristics that predict HD patients' long-term prognoses after PCI that included RA in the drug-eluting stent (DES) era.
Methods:
This study included 302 patients who underwent regular HD from J2T Multicenter Registry database of 1090 consecutive patients who underwent RA to treat de novo calcified lesions at three university hospitals between 2004 and 2015. The primary endpoint was cardiovascular (CV) death.
Results:
During the 5-year observation period, 59 CV deaths (19.5%) occurred. The CV death group and non-CV death group had comparable profiles except significantly lower left ventricular ejection fraction, higher brain natriuretic peptide (BNP), lower rate of RA burr upsizing, and lower rate of final thrombolysis in myocardial infarction (TIMI) 3 flow achievement in the CV death group. Cox regression analysis revealed that increasing ablation burr size (hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.13-0.81), final TIMI 3 flow (HR: 0.07; 95% CI: 0.02-0.28), lower BNP level, and optimal medication were independently associated with better CV mortality in HD patients.
Conclusion:
In the DES era, oral medications at the time of PCI and stepwise calcium ablation were associated with improved long-term CV mortality in HD patients who are scheduled to undergo RA to treat severely calcified coronary artery stenoses, as therapeutic strategies.
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