所属 医学部 医学科（東京女子医科大学病院） 職種 特任教授
|発表タイトル||Predictors for long-term cardiovascular death after rotational atherectomy in patients with regular hemodialysis - from J2T multicenter registry -|
|会議名||ESC CONGRESS 2017|
|主催者||European Society of Cardiology|
|発表者・共同発表者||JUJO Kentaro, OTSUKI Hisao, ◎TANAKA Kazuki, I.Okai, M.Nakashima, T.Dohi, S.Okazaki, H.Kawashima, Y.Nara, H.Kyono, YAMAGUCHI Junichi, K.Miyauchi, H.Daida, K.Kozuma, HAGIWARA Nobuhisa|
|概要||Background: Patients with regular hemodialysis (HD) frequently have a heavy calcium in the stenotic coronary arteries, and show poorer prognosis after percutaneous coronary intervention (PCI) than those without HD. Rotational atherectomy (RA) is one of the strategic options for technical success of PCI in the severely calcified lesion.
Purpose: We aimed to identify clinical and procedural features predicting long-term clinical prognosis of HD patients after PCI with RA in the drug-eluting stent (DES) era.
Methods: This study included 1,134 consecutive patients who underwent PCI with RA at three university hospitals between 2004 and 2014. Among them, 316 patients on regular HD were ultimately analyzed. The primary endpoint of this study was cardiovascular (CV) death.
Results: The study population was typically middle age (65 years-old), and 81% male with a normal BMI (23 kg/m2) and diverse comorbidities, including 66% diabetes, 31% insulin use, 57% dyslipidemia and 45% prior revascularization therapy. At the time of PCI, bare metal stents were implanted only in 10% of the study population, and 1st generation DES in 49%. During 1,105 days of median observational period, CV death was observed in 19% (60 patients) of the study population. Cox regression analysis revealed that the step-up of ablation burr size and final TIMI 3 flow were independent predictors for CV death as well as brain natriuretic peptide (BNP), triglyceride, and oral medications (Table).
Conclusion: In the DES era, optimal medication and sufficient ablation of calcium should be considered for HD patients who were treated with RA against severe calcified coronary artery stenosis, in order to improve long-term CV mortality.