Artículos de revistas
Treatment of Coronary Artery Disease in Hemodialysis Patients Evaluated for Transplant-A Registry Study
Fecha
2010Registro en:
TRANSPLANTATION, v.89, n.7, p.845-850, 2010
0041-1337
10.1097/TP.0b013e3181cab241
Autor
LIMA, Jose Jayme G. De
GOWDAK, Luis Henrique W.
PAULA, Flavio Iota de
ARANTES, Rodolfo L.
OLIVEIRA, Andre Luis Veiga de
RAMIRES, Jose Antonio F.
CESAR, Luiz Antonio M.
KRIEGER, Eduardo M.
Institución
Resumen
Background. We assessed the results of a noninvasive therapeutic strategy on the long-term occurrence of cardiac events and death in a registry of patients with chronic kidney disease (CKD) and coronary artery disease (CAD). Methods. We analyzed 519 patients with CKD (56+/-9 years, 67% men, 67% whites) on maintenance hemodialysis with clinical or scintigraphic evidence of CAD by using coronary angiography. Results. In 230 (44%) patients, coronary angiography revealed significant CAD (lumen reduction >= 70%). Subjects with significant CAD were kept on medical treatment (MT; n=184) or referred for myocardial revascularization (percutaneous transluminal coronary angioplasty/coronary artery bypass graft-intervention; n=30) according to American College of Cardiology/American Heart Association guidelines. In addition, 16 subjects refused intervention and were also followed-up. Event-free survival for patients on MT at 12, 36, and 60 months was 86%, 71%, and 57%, whereas overall survival was 89%, 71%, and 50% in the same period, respectively. Patients who refused intervention had a significantly worse prognosis compared with those who actually underwent intervention (events: hazard ratio=4.50; % confidence interval=1.48-15.10; death: hazard ratio=3.39; % confidence interval 1.41-8.45). Conclusions. In patients with CKD and significant CAD, MT promotes adequate long-term event-free survival. However, failure to perform a coronary intervention when necessary results in an accentuated increased risk of events and death.