Lee Michael S, Shlofmitz Evan, Lluri Gentian, Shlofmitz Richard A
UCLA Medical Center, 100 Medical Plaza Suite 630, Los Angeles, CA 90095 USA.
J Invasive Cardiol. 2017 Jun;29(6):203-206. Epub 2017 Jan 15.
We evaluated the clinical outcomes of patients with chronic kidney disease (CKD) who underwent orbital atherectomy for severe coronary artery calcification (CAC) prior to stent implantation.
Percutaneous coronary intervention (PCI) of lesions with severe CAC is associated with increased rates of adverse clinical events. Patients with CKD are at increased risk for atherosclerotic cardiovascular disease, including vascular calcification, and have worse outcomes after PCI.
Of the 456 consecutive real-world patients in our retrospective multicenter registry with severe CAC who underwent orbital atherectomy, 88 patients (19.3%) had CKD (creatinine ≥1.5 mg/dL). The primary endpoint was the 30-day rate of major adverse cardiac and cerebrovascular event (MACCE), defined as death, myocardial infarction (MI), target-vessel revascularization (TVR), and stroke.
The CKD group had a higher prevalence of diabetes mellitus and hypertension as well as a lower mean left ventricular ejection fraction. The primary endpoint was similar in the CKD and non-CKD groups (3.4% vs 1.9%; P=.40), as were 30-day rates of death (2.2% vs 1.1%; P=.30), MI (1.1% vs 0.5%; P=.40), TVR (0% vs 0%; P>.99), and stroke (0% vs 0.3%; P>.99). Angiographic complications and stent thrombosis rates were low and did not differ between the two groups.
Despite higher-risk baseline characteristics, patients with CKD had no significant differences in MACCE. Orbital atherectomy represents a reasonable treatment strategy for the treatment of severe CAC in patients with CKD. A prospective randomized trial with long-term follow-up is needed to identify the optimal treatment for these patients.
我们评估了慢性肾脏病（CKD）患者在支架植入术前接受冠状动脉旋磨术治疗严重冠状动脉钙化（CAC）的临床结局。
严重CAC病变的经皮冠状动脉介入治疗（PCI）与不良临床事件发生率增加相关。CKD患者发生动脉粥样硬化性心血管疾病（包括血管钙化）的风险增加，且PCI术后结局更差。
在我们回顾性多中心注册研究中，456例连续的接受冠状动脉旋磨术治疗严重CAC的真实世界患者中，88例（19.3%）患有CKD（肌酐≥1.5mg/dL）。主要终点是30天主要不良心脑血管事件（MACCE）发生率，定义为死亡、心肌梗死（MI）、靶血管血运重建（TVR）和卒中。
CKD组糖尿病和高血压患病率更高，平均左心室射血分数更低。CKD组和非CKD组的主要终点相似（3.4%对1.9%；P=0.40），30天死亡率（2.2%对1.1%；P=0.30）、MI发生率（1.1%对0.5%；P=0.40）、TVR发生率（0%对0%；P>0.99）和卒中发生率（0%对0.3%；P>0.99）也相似。血管造影并发症和支架血栓形成率较低，两组之间无差异。
尽管基线特征风险更高，但CKD患者的MACCE无显著差异。冠状动脉旋磨术是治疗CKD患者严重CAC的合理治疗策略。需要进行一项长期随访的前瞻性随机试验，以确定这些患者的最佳治疗方法。
