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      Impact of intravascular ultrasound-guided minimum-contrast coronary intervention on 1-year clinical outcomes in patients with stage 4 or 5 advanced chronic kidney disease.

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          Abstract

          This study aims to elucidate 1-year clinical outcomes using this technique for patients with stage 4 or 5 advanced chronic kidney disease (CKD). Research has proven that imaging-guided percutaneous coronary intervention (PCI) reduces contrast volume significantly; however, only short-term clinical benefits have been reported. Minimum-contrast (MINICON) studies are based on the registry design pattern to enroll PCI results in patients with advanced CKD stage 4 or 5 comorbid with coronary artery disease. We excluded cases of emergency PCI or maintenance dialysis from this study. In this study, we compared the intravascular ultrasound (IVUS)-guided MINICON PCI group (n = 98) with the angiography-guided standard PCI group (n = 86). Enrollment of the MINICON studies started in 2006. Before 2012, IVUS-guided MINICON PCI was performed only in 14% (stage 1), but it was 100% after 2012 (stage 2). The enrollment finished in 2016. The IVUS-guided MINICON PCI group exhibited a significantly reduced contrast volume (22 ± 20 vs. 130 ± 105 mL; P < 0.0001) and contrast-induced acute kidney injury (CI-AKI; 2% vs. 15%; P = 0.001). The PCI success rate was similarly high (100% vs. 99%; P = 0.35). At 1 year (follow-up rate, 100%), we observed less induction of renal replacement therapy (RRT; 2.7% vs. 13.6%; P = 0.01), but all-cause mortality or myocardial infarction was similar in both groups. The IVUS-guided MINICON PCI reduces CI-AKI significantly and induction of RRT at 1 year in patients with stage 4 or 5 advanced CKD.

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          Author and article information

          Journal
          Cardiovasc Interv Ther
          Cardiovascular intervention and therapeutics
          Springer Science and Business Media LLC
          1868-4297
          1868-4297
          Jul 2019
          : 34
          : 3
          Affiliations
          [1 ] Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
          [2 ] Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. ikari@is.icc.u-tokai.ac.jp.
          [3 ] Cardiovascular Center, Nagoya Daini Red Cross Hospital, 2-9 Myoukencho, Shouwaku, Nagoya, 466-8650, Japan.
          [4 ] Seirei Fuji Hospital, 3-1 Minamicho, Fuji, Shizuoka, 417-0026, Japan.
          [5 ] Nozaki Tokushukai Hospital, 2-10-50 Tanigawa, Daito, Osaka, 574-0074, Japan.
          [6 ] Kasugai Municipal Hospital, 1-1 Takakicho, Kasugai, Aichi, 486-8510, Japan.
          [7 ] Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
          [8 ] Saga-ken Medical Centre Koseikan, 400 Kasemachinakabaru, Saga City, Saga, 840-0861, Japan.
          [9 ] Medical Corporation Kawasaki Hospital, 3-3-1 Higashiyamacho, Hyogoku, Kobe, Hyogo, 652-0042, Japan.
          [10 ] Japan Community Health Care Organization Osaka Hospital, 4-2, Fukushima, Fukusimaku, Osaka, Japan.
          [11 ] Municipal Tsuruga Hospital, 1-6-60, mishimacho, Tsuruga City, Fukui, Japan.
          Article
          10.1007/s12928-018-0552-7
          10.1007/s12928-018-0552-7
          30343351
          ff93fe51-4f4d-4d53-94fb-650c95e37e02
          History

          Coronary artery disease,Renal failure,Prognosis
          Coronary artery disease, Renal failure, Prognosis

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