Document Detail


Treatment of coronary artery disease in hemodialysis patients evaluated for transplant-a registry study.
MedLine Citation:
PMID:  20019646     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We assessed the results of a noninvasive therapeutic strategy on the long-term occurrence of cardiac events and death in a registry of patients with chronic kidney disease (CKD) and coronary artery disease (CAD). METHODS: We analyzed 519 patients with CKD (56+/-9 years, 67% men, 67% whites) on maintenance hemodialysis with clinical or scintigraphic evidence of CAD by using coronary angiography. RESULTS: In 230 (44%) patients, coronary angiography revealed significant CAD (lumen reduction > or =70%). Subjects with significant CAD were kept on medical treatment (MT; n=184) or referred for myocardial revascularization (percutaneous transluminal coronary angioplasty/coronary artery bypass graft-intervention; n=30) according to American College of Cardiology/American Heart Association guidelines. In addition, 16 subjects refused intervention and were also followed-up. Event-free survival for patients on MT at 12, 36, and 60 months was 86%, 71%, and 57%, whereas overall survival was 89%, 71%, and 50% in the same period, respectively. Patients who refused intervention had a significantly worse prognosis compared with those who actually underwent intervention (events: hazard ratio=4.50; % confidence interval=1.48-15.10; death: hazard ratio=3.39; % confidence interval 1.41-8.45). CONCLUSIONS: In patients with CKD and significant CAD, MT promotes adequate long-term event-free survival. However, failure to perform a coronary intervention when necessary results in an accentuated increased risk of events and death.
Authors:
Jos? Jayme G De Lima; Lu?s Henrique W Gowdak; Fl?vio Jota de Paula; Rodolfo L Arantes; Andr? Lu?s Veiga de Oliveira; Jose Antonio F Ramires; Luiz Antonio M C?sar; Eduardo M Krieger
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Transplantation     Volume:  89     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-13     Completed Date:  2010-04-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  845-50     Citation Subset:  IM    
Affiliation:
Heart Institute (InCor), Hospital das Clinicas, University of S?o Paulo Medical School, S?o Paulo, Brazil. jose.lima@incor.usp.br
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Brazil / epidemiology
Cardiovascular Agents / therapeutic use*
Cardiovascular Diseases / etiology,  mortality,  prevention & control*
Coronary Angiography
Coronary Artery Bypass*
Coronary Stenosis / complications,  mortality,  radiography,  therapy*
Disease Progression
Disease-Free Survival
Female
Humans
Kaplan-Meiers Estimate
Kidney Diseases / complications,  mortality,  surgery,  therapy*
Kidney Transplantation*
Male
Middle Aged
Practice Guidelines as Topic
Proportional Hazards Models
Registries
Renal Dialysis*
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Treatment Refusal
Waiting Lists
Chemical
Reg. No./Substance:
0/Cardiovascular Agents
Comments/Corrections
Comment In:
Transplantation. 2010 Apr 15;89(7):807-8   [PMID:  20061997 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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