Nephrol Dial Transplant (2001) 16: 1198-1202
© 2001 European Renal Association-European Dialysis and Transplant Association
Angiographic progression of coronary artery disease in patients with end-stage renal disease
1 Klinik für Kardiologie, Pneumologie und Angiologie, and 2 Klinik für Nephrologie und Rheumatologie, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
Background. Patients with end-stage renal disease have an increased risk of developing coronary artery disease (CAD). The cardiovascular mortality of dialysis patients is 10–15 times higher compared with the general population. The aim of our study was to evaluate the morphological progression of coronary arteriosclerosis in this cardiovascular high-risk group by visual assessment and quantitative coronary angiography.
Methods and results. In 26 patients with chronic renal failure (age, 47±11 years; 15 male; duration of dialysis, 23±25 months) the severity of CAD and degree of coronary stenoses were assessed in two coronary angiograms after a mean follow-up interval of 30±15 months (12–60). Baseline angiography revealed CAD in 13/22 patients (59%). The second angiography was performed as screening procedure prior to renal transplantation (n=20) and/or as follow-up angiography after coronary angioplasty (n=10). Visual assessment showed a progression defined by the development of haemodynamically relevant stenosis of >50% luminal diameter in 13 patients. Quantitative angiographic evaluation was performed in a total of 45 segments showing >25% narrowing at the second angiogram. A progression (>15% luminal reduction) was found in 17 of 45 segments, a new lesion (initial luminal diameter <20%) was detected in nine segments, resulting in progression or new lesion in 16 patients (62%). Patients with or without progression did not differ in age, duration of dialysis treatment, number of cardiovascular risk factors, or serum total cholesterol and fibrinogen levels. After percutaneous transluminal coronary angioplasty (PTCA) a restenosis was seen in seven of 16 primarily successfully dilated segments. After the second angiography, myocardial revascularization was performed in eight patients (1 PTCA, 7 coronary artery bypass graft).
Conclusions. Patients with end-stage renal disease have a high prevalence of CAD. In line with the clinical course, CAD patients on maintenance dialysis undergo rapid angiographic progression of CAD, which results in a high rate of subsequent myocardial revascularizations.
Keywords: angiography; coronary artery disease; cardiovascular mortality; end-stage renal disease; morphological progression
Correspondence and offprint requests to: Frank Gradaus MD, Klinik für Kardiologie, Pneumologie und Angiologie, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  O.-P. Kangasniemi, M. A. A. Mahar, E. Rasinaho, A. Satomaa, V. Tiozzo, M. Lepojarvi, and F. Biancari Impact of estimated glomerular filtration rate on the 15-year outcome after coronary artery bypass surgery Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 198 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. L. Lentine, D. C. Brennan, and M. A. Schnitzler Incidence and Predictors of Myocardial Infarction after Kidney Transplantation J. Am. Soc. Nephrol., February 1, 2005; 16(2): 496 - 506. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Gibson, R. L. Dumaine, E. V. Gelfand, S. A. Murphy, D. A. Morrow, S. D. Wiviott, R. P. Giugliano, C. P. Cannon, E. M. Antman, E. Braunwald, et al. Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13307 patients in five TIMI trials Eur. Heart J., November 2, 2004; 25(22): 1998 - 2005. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Herzog How to Manage the Renal Patient with Coronary Heart Disease: The Agony and the Ecstasy of Opinion-Based Medicine J. Am. Soc. Nephrol., October 1, 2003; 14(10): 2556 - 2572. [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Lins, K. E. Matthys, G. A. Verpooten, P. C. Peeters, M. Dratwa, J.-C. Stolear, and N. H. Lameire Pharmacokinetics of atorvastatin and its metabolites after single and multiple dosing in hypercholesterolaemic haemodialysis patients Nephrol. Dial. Transplant., May 1, 2003; 18(5): 967 - 976. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Elisaf and D. P. Mikhailidis Statins and Renal Function Angiology, September 1, 2002; 53(5): 493 - 502. [Abstract] [PDF]
|
|