NDT Advance Access originally published online on December 15, 2008
Nephrology Dialysis Transplantation 2009 24(5):1562-1567; doi:10.1093/ndt/gfn685
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Aortic valvular calcification predicts restenosis after implantation of drug-eluting stents in patients on chronic haemodialysis
1 Department of Cardiology, Nagoya University Graduate School of Medicine 2 Cardiolovasucular Center, Nagoya Kyoritsu Hospital 3 Department of Clinical Immunology, Nagoya University Graduate School of Medicine 4 Department of Internal Medicine, School of Dentistry Aichi-Gakuin University, Nagoya, Japan
Correspondence and offprint requests to: Hideki Ishii, Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Tel: +81-52-744-2147; Fax: +81-52-744-2157; E-mail: hkishii{at}med.nagoya-u.ac.jp
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Abstract |
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Background. Even in the drug-eluting stent (DES) era, the restenosis rate of the follow-up period after percutaneous coronary intervention (PCI) is higher in haemodialysis (HD) patients than in non-HD patients. Therefore, higher restenosis remains a clinical limitation in HD patients, and a simple clinical method to predict patients likely to have restenosis after stent implantation is attractive. The present study investigated the potential relationship between aortic valvular calcification (AVC) and angiographical restenosis at follow-up after DES implantation in patients on maintenance HD.
Methods. In the study, 97 patients were enrolled. We prospectively performed echocardiography before elective PCI with DES implantation. Angiographic follow-up was scheduled between 6 and 8 months after PCI. Restenosis at follow-up was defined as a diameter stenosis of 
50% by measuring quantitative coronary angiography.
Results. Of the enrolled patients, 59 patients (60.8%) had AVC. Complete angiographical follow-up was obtained in 86 patients (88.7%). The angiographical restenosis rate during the follow-up period was 24.7% in patients with AVC and 8.9% in patients without AVC [hazard ratio (HR) 3.36; 95% confidence interval (CI) 1.18–9.56, P = 0.023]. Even after multivariate adjustment including covariates related to atherogenecity, AVC remained an independent predictor of restenosis after implanting DES (HR 3.83; 95% CI 1.14–12.9, P = 0.029). Late lumen loss suggesting neointimal growth after DES implantation was 0.28 ± 0.70 mm in the non-AVC group and 0.64 ± 0.90 mm in the AVC group (P = 0.013).
Conclusions. AVC provides predictive information regarding DES implantation in patients on maintenance HD.
Keywords: aortic valvular calcification; coronary artery disease; drug-eluting stent; haemodialysis; percutaneous coronary intervention
Received for publication: 18. 9.08
Accepted in revised form: 17.11.08