Nephrol Dial Transplant (2002) 17: 100-105
© 2002 European Renal Association-European Dialysis and Transplant Association
Favourable long-term outcome by repeated percutaneous coronary revascularization in diabetic haemodialysis patients
1 Third Department of Internal Medicine, Division of Nephrology and 2 Division of Cardiology, Ohashi Hospital, Toho University School of Medicine, 3 Division of Dialysis Center, Nissan Tamagawa Hospital and 4 Komazawa Renal Clinic, Tokyo, Japan
Background. Diabetic haemodialysis patients have a high prevalence of coronary events and very high mortality rates. Percutaneous coronary intervention has become a well-established and routine procedure for coronary revascularization. This study investigated the long-term outcome of multiple repeated interventions in diabetic haemodialysis patients with coronary artery disease.
Methods. A retrospective study compared 37 type II diabetic haemodialysis patients with coronary artery disease and 26 non-diabetic patients matched for age, angiographic morphology, and devices of percutaneous intervention. All patients had undergone successful percutaneous intervention prior to enrolment. Percutaneous interventions were repeated in the event of restenosis or the development of a de novo lesion.
Results. Diabetic and non-diabetic patients were similar in terms of the number of follow-up angiograms (2.3±1.6 vs 2.4±1.5/patient) and interventions (2.2±1.4 vs 2.2±1.5/patient), incidence of target lesion revascularization (85 vs 82%), and number of de novo lesions (15 vs 17%). The cumulative survival rates after the initial percutaneous intervention were similar in the groups (42% vs 31% at 80 months). Cardiac death occurred in 33% of diabetic patients and 42% of non-diabetic patients. Repeated intervention (regression coefficient=16.0, P<0.001) and a lower left ventricular ejection fraction (regression coefficient=-12.9, P=0.047) were determined for the important clinical factors associated with the survival duration after initial coronary intervention.
Conclusions. Multiple repeated percutaneous interventions reduce the long-term mortality of diabetic and non-diabetic haemodialysis patients with coronary artery disease similarly. Multiple repeated percutaneous coronary interventions are a viable option for controlling myocardial ischaemia and improving the long-term outcome in high-risk diabetic haemodialysis patients.
Keywords: coronary artery disease; diabetes mellitus; haemodialysis; repeated intervention; survival
Correspondence and offprint requests to: Hiroki Hase, Third Department of Internal Medicine, Toho University Ohashi Hospital, Ohashi 2-17-6, Meguro-Ku, Tokyo 153-8515, Japan. Email: hiroki{at}oha.toho\|[hyphen]\|u.ac.jp.
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