It's not the dye, but the “die” in dialysis: Which coronary revascularization strategy really is best?
✍ Scribed by Samuel M. Butman
- Publisher
- John Wiley and Sons
- Year
- 2010
- Tongue
- English
- Weight
- 38 KB
- Volume
- 76
- Category
- Article
- ISSN
- 1522-1946
No coin nor oath required. For personal study only.
✦ Synopsis
It is pretty safe to say that if you are reading this editorial before or after reading the preceding article, you already know that patients on hemodialysis have a poor prognosis . Furthermore, you know that they are at higher risk, when intervened upon, and you are wondering what, if any insight, this meta-analysis might provide you before you delve into the next patient with renal failure.
The authors concluded that drug-eluting stents (DES) are safe and that significant reductions in target lesion and vessel revascularization are seen when compared to bare metal stents (BMS). Furthermore, when compared to uncoated stents, MACE is also reduced. No surprises here and that is a good thing. However, in this meta-analysis, the authors did not find a statistically significant difference in the incidence of myocardial infarction. Always troubling, surprising, even perhaps, but not the first time that favorable outcomes with revascularization were found without a concomitant reduction in the incidence of myocardial infarction. The classic prospective and randomized Veteran's Administration and European Cooperative trials of coronary artery bypass surgery also did not show a reduction in the incidence of myocardial infarction, despite improved survival in left main and a few subsets of multivessel coronary artery disease when compared with medical therapy . Still troubling, however.
Patients with renal failure have a poorer prognosis than many subgroups of patients with coronary artery disease. Not news. Too many of these dialysis-dependent patients have diabetes as a backdrop, systemic hypertension is the rule rather than the exception, many are anemic, and of course, coronary calcification is rampant. As the authors state, ''CAD and cardiovascular disorders in general represent the single most significant comorbid condition for ESRD patients on hemodialysis, leading to 45% of deaths.''