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      Long-Term Outcome after Percutaneous Transluminal Coronary Angioplasty in Patients with Chronic Renal Failure with and without Diabetic Nephropathy

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          Objective: Percutaneous transluminal coronary angioplasty (PTCA) in patients on maintenance hemodialysis leads to high rates of restenosis and postinterventional complications. The additional influence of diabetes mellitus on the results of PTCA in patients with diabetic nephropathy and reduced but sufficient renal function has not been investigated before. Methods: In a retrospective case-control study, 51 patients with reduced renal function were compared to 71 matched controls. Patients with elevated creatinine values were divided in two subgroups: diabetic nephropathy (diabetes, n = 15) and stable renal insufficiency (renal failure, n = 36). Results: The control group had normal renal function (creatinine: 1.0 ± 0.01) and a mean survival time of 3.6 ± 0.8 years. Patients with renal failure showed a mean survival time of 2.7 ± 0.3 years (p < 0.001), creatinine values of 2.0 ± 0.2 and elevated fibrinogen values of 401 ± 28 (p < 0.01). Patients with diabetes (creatinine: 2.2 ± 0.2) had a significantly higher mortality rate with a reduced mean survival time of 1.25 ± 0.3 years (p < 0.001), postinterventional acute renal failure (n = 2, p < 0.01) and Re-PTCA (n = 2, p < 0.05). Discussion: Patients with reduced but stable renal function showed a higher mortality than comparable patients from the control group. The group of patients with diabetic nephropathy has a poor prognosis after PTCA even though renal function was only moderately reduced.

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          Efficacy of Percutaneous Transluminal Coronary Angioplasty for Patients on Hemodialysis

          Ischemic heart disease has become more important in regard to mortality in hemodialysis (HD) patients. We examined the therapeutic outcome of initial percutaneous transluminal angioplasty (PTCA) in maintenance HD patients with angina pectoris. They consisted of 8 men and 4 women with a mean age of 56.3 ± 8.6 years and a mean duration of HD of 4.3 ± 4.0 years. Thirty-six non-HD patients treated with initial PTCA were matched for age, sex and coronary risk factors, and used as a control. Angiographic lesion success was confirmed by angiography in 21 (84%) of the 25 stenotic sites attempted and clinical success was obtained in 9 (75%) of the 12 HD patients, while there were 40 (78%) lesions successfully removed out of the 51 stenotic sites and there were 26 (72%) clinically successful cases out of the 36 non-HD patients, respectively. Angina recurred in 4 (44%) of 9 HD patients, and in 10 (38%) of 26 non-HD patients after successful PTCA, where the follow-up periods were 23 ± 20 and 28 ± 25 months, respectively. There was no significant difference in cumulative lesion survival curve between the two groups. In conclusion, PTCA for chronic HD patients is as effective as that for non-HD patients, at least regarding initial PTCA.
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            Coronary Artery Diameter and Left Ventricular Function in Patients on Maintenance Hemodialysis Treatment: Comparison between Diabetic and Nondiabetic Patients

            Background/Aims: This study examined the role of diabetes mellitus on determining left ventricular function by evaluating coronary artery diameter in patients with end-stage renal disease on maintenance hemodialysis treatment. Methods: We studied 12 diabetic and 12 nondiabetic patients on maintenance hemodialysis treatment without significant stenoses of the major epicardial coronary arteries. Patients were matched for age, sex distribution, duration of dialysis and incidence of major coronary risk factors. Left ventricular wall thickness (septal and posterior walls) and left ventricular diameter (end-diastolic and systolic phases), were measured by echocardiography. Hemodynamic measurements and coronary angiography were performed on the day of hemodialysis and coronary artery diameter at the proximal and mid portion of three major coronary arteries were measured using the computed densitometry method. Results: Right and left anterior descending and circumflex coronary artery diameters were all significantly smaller and the frequency of coronary artery calcification was higher in diabetic (58%) compared to nondiabetic (8%) patients. Although there were no significant differences in left ventricular wall thickness, left ventricular diameter, mean right atrial pressure and cardiac index between the two groups, left ventricular end-diastolic pressure was significantly higher in diabetic (22 ± 9 mm Hg) compared to nondiabetic patients (14 ± 5 mm Hg). Conclusion: Despite that there were no significant stenoses of the major epicardial coronary arteries, diffuse luminal narrowing of the epicardial coronary arteries in diabetic patients on maintenance hemodialysis treatment was associated with increased left ventricular end-diastolic pressure.

              Author and article information

              S. Karger AG
              24 August 2001
              : 89
              : 1
              : 10-14
              aMedizinische Poliklinik, Innere Medizin D und bMedizinische Klinik und Poliklinik, Innere Medizin C (Kardiologie und Angiologie) und Institut für Arterioskleroseforschung, Westfälische Wilhelm Universität, Münster, Deutschland
              46036 Nephron 2001;89:10–14
              © 2001 S. Karger AG, Basel

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              Figures: 1, Tables: 2, References: 16, Pages: 5
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