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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

16.7K

Better Prognosis After Complete Revascularization Using Contemporary Coronary Stents in Patients With Chronic Kidney

Doyeon Hwang1, Jeehoon Kang1, Han-Mo Yang1

  • 1Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea.

Circulation. Cardiovascular Interventions
|July 27, 2019
PubMed

Insights

Complete revascularization with drug-eluting stents improves outcomes for patients with chronic kidney disease (CKD). A lower residual SYNTAX score target is beneficial for CKD patients, suggesting more aggressive treatment.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Prognostic value of complete revascularization in chronic kidney disease (CKD) using contemporary stents is understudied.
  • Second-generation drug-eluting stents are widely used for coronary revascularization.

Purpose of the Study:

  • To compare clinical outcomes of complete versus incomplete revascularization in patients with and without CKD.
  • To evaluate the prognostic impact of angiographic complete revascularization in CKD patients treated with second-generation drug-eluting stents.

Main Methods:

  • Retrospective analysis of 8471 patients from the Grand Drug-Eluting Stent Registry.
  • Patients were stratified into CKD (n=3014) and preserved renal function (n=5457) groups.
  • Complete revascularization defined as a residual SYNTAX score of 0; primary outcome was a 3-year patient-oriented composite outcome.

Main Results:

  • Complete revascularization significantly reduced patient-oriented composite outcomes in both CKD (14.6% vs 21.8%) and preserved renal function groups (8.0% vs 12.0%).
  • Adjusted hazard ratios favored complete revascularization in both groups (CKD: 0.79; preserved function: 0.77).
  • Optimal residual SYNTAX score cutoffs for better outcomes were lower in CKD patients (<3) compared to those with preserved renal function (<8).

Conclusions:

  • Angiographic complete revascularization improves clinical outcomes in patients with CKD and preserved renal function.
  • A lower residual SYNTAX score target is recommended for CKD patients, indicating a need for more aggressive revascularization strategies.
  • These findings support tailored revascularization approaches based on renal function status.
Abstract

Keywords:
coronary artery diseasedrug-eluting stentpercutaneous coronary interventionrenal insufficiency

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