Rollino C, Formica M, Minelli M, Boero R, Beltrame G, Bonello F, Pignataro A, Borsa S, Quarello F
Department of Nephrology and Cardiology, Giovanni Bosco Hospital, Turin, Italy.
Ren Fail. 2000;22(5):605-11. doi: 10.1081/jdi-100100901.
Cardiovascular disease accounts for almost half of the total mortality in patients with end stage renal disease (ESRD). It has recently been debated whether coronary revascularization has the same rate of risks and successes in this cohort of patients compared to patients without renal disease. Since 1991, 17 dialysis patients were submitted to coronary revascularization in our center. Seven patients were following peritoneal, 10 hemodialytic treatment. Four patients were submitted to percutaneous transluminal coronary angioplasty (PTCA) and 13 to surgical revascularization (CABG). In 2 patients the coronary lesion was unique, in the others stenosis of multiple vessels were found. Six patients were diabetic. The mean age at the onset of the coronary artery disease (CAD) was 57.17 +/- 11.6 years. The mean time elapsed from the onset of the CAD and the performance of the PTCA or CABG was 30.1 +/- 35.4 months. The mean time from beginning of dialysis treatment to revascularization was 48.2 +/- 39.6 months. Mean hemoglobin values were 9.7 +/- 1 g/dL, mean phosphorus values were 5.2 +/- 8.7 mg/dL, mean cholesterol values were 211 +/- 49.5 mg/dL. The procedure was technically successful in all patients. Mean survival was 25.09 +/- 28.12 months. Twelve patients died, 5 of whom within one month. Survival at one month was 70.5%, at 6 months 58.8%, at one year 52.9%, at 2 years 47%. There was neither significant difference patients submitted to PTCA and those submitted to CABG, nor between diabetic and non-diabetic patients. In conclusion, coronary revascularization in our experience is a high risk procedure in dialysis patients. The reasons for this could be the severe general conditions of these patients affected with diffuse vasculopathy and the long time elapsed since the onset of the ischemic cardiopathy. Thus, our results could suggest the opportunity of performing earlier screening of coronary situation and revascularization treatment in CAD dialysis patients.
心血管疾病占终末期肾病（ESRD）患者总死亡率的近一半。最近，对于与无肾病患者相比，冠状动脉血运重建在这组患者中的风险和成功率是否相同存在争议。自1991年以来，我们中心有17名透析患者接受了冠状动脉血运重建。7名患者接受腹膜透析，10名接受血液透析治疗。4名患者接受了经皮腔内冠状动脉成形术（PTCA），13名接受了外科血运重建（冠状动脉旁路移植术，CABG）。2例患者的冠状动脉病变为单发，其他患者发现多支血管狭窄。6例患者患有糖尿病。冠心病（CAD）发病时的平均年龄为57.17±11.6岁。从CAD发病到进行PTCA或CABG的平均时间为30.1±35.4个月。从开始透析治疗到血运重建的平均时间为48.2±39.6个月。平均血红蛋白值为9.7±1g/dL，平均磷值为5.2±8.7mg/dL，平均胆固醇值为211±49.5mg/dL。该手术在所有患者中技术上均获成功。平均生存期为25.09±28.12个月。12例患者死亡，其中5例在一个月内死亡。1个月时的生存率为70.5%，6个月时为58.8%，1年时为52.9%，2年时为47%。接受PTCA和接受CABG的患者之间以及糖尿病患者和非糖尿病患者之间均无显著差异。总之，根据我们的经验，冠状动脉血运重建在透析患者中是一项高风险手术。原因可能是这些患者患有弥漫性血管病变，一般状况较差，且自缺血性心脏病发病以来已过去很长时间。因此，我们的结果可能提示对CAD透析患者进行更早的冠状动脉情况筛查和血运重建治疗的必要性。
