所属 医学部 医学科（東京女子医科大学病院） 職種 特任教授
|表題||Long-term cardiovascular prognosis after rotational atherectomy in hemodialysis patients: Data from the J2T multicenter registry.|
|掲載誌名||正式名：International journal of cardiology|
略 称：Int J Cardiol
|著者・共著者||JUJO Kentaro†*, OTSUKI Hisao, TANAKA Kazuki, FUKUSHIMA Noritoshi, OKAI Iwao, NAKASHIMA Makoto, DOHI Tomotaka, OKAZAKI Shinya, OKABE Ryuta, NAGURA Fukuko, NARA Yugo, KAWASHIMA Hideyuki, KYONO Hiroyuki, ARASHI Hiroyuki, YAMAGUCHI Junichi, TAMURA Hiroshi, KURATA Takeshi, MIYAUCHI Katsumi, KOZUMA Ken, DAIDA Hiroyuki, HAGIWARA Nobuhisa|
Hemodialysis (HD) patients have heavy calcium deposits in their stenotic coronary arteries and worse post-percutaneous coronary intervention (PCI) prognoses than those who do not undergo HD. Rotational atherectomy (RA) facilitates PCI success in severely calcified lesions. We aimed to identify clinical and procedural characteristics that predict HD patients' long-term prognoses after PCI that included RA in the drug-eluting stent (DES) era.
This study included 302 patients who underwent regular HD from J2T Multicenter Registry database of 1090 consecutive patients who underwent RA to treat de novo calcified lesions at three university hospitals between 2004 and 2015. The primary endpoint was cardiovascular (CV) death.
During the 5-year observation period, 59 CV deaths (19.5%) occurred. The CV death group and non-CV death group had comparable profiles except significantly lower left ventricular ejection fraction, higher brain natriuretic peptide (BNP), lower rate of RA burr upsizing, and lower rate of final thrombolysis in myocardial infarction (TIMI) 3 flow achievement in the CV death group. Cox regression analysis revealed that increasing ablation burr size (hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.13-0.81), final TIMI 3 flow (HR: 0.07; 95% CI: 0.02-0.28), lower BNP level, and optimal medication were independently associated with better CV mortality in HD patients.
In the DES era, oral medications at the time of PCI and stepwise calcium ablation were associated with improved long-term CV mortality in HD patients who are scheduled to undergo RA to treat severely calcified coronary artery stenoses, as therapeutic strategies.