Hemodialysis is an Independent Predictor of Coronary In-stent Restenosis after Paclitaxel Eluting Stent Implantation
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概要
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Objective A drug eluting stent is often used for high-risk patients with complications such as diabetes mellitus (DM) and hemodialysis (HD), however the factors to predict restenosis after paclitaxel-eluting stent (PES) placement have not been reported to date. Methods Between May 2007 and August 2009, 165 consecutive patients (231 stents) received PES in our hospital. Stent diameter and length were determined by the use of intravascular ultrasound (IVUS). All patients continued to take 2 types of anti-platelet agents (aspirin and Clopidogrel or Ticlopidine). Ninety percent of the subjects received a follow-up coronary angiogram 6 months later. Results Underlying diseases were hypertension in 75%, hyperlipidemia in 78% and DM in 60% (15% on insulin), and 14% of the subjects received HD. Eighty-three percent of the patients had orally taken Statin, 85% ACE/ARB and 68% had beta blockers. Mean length and diameter of PES were 21.6 ± 7.2 mm and 2.9 ± 0.3 mm, respectively. Target lesion revascularization (TLR) rate 6 months after PES placement was 14.6% overall. In HD patients TLR was 43%, hypertension 15.0%, hyperlipemia 12.4%, DM with oral medication 12.5%, DM with insulin 12.0%, respectively. In multivariate analysis, HD was an independent risk factor for TLR (p=0.0001, OR: 6.61, 95% C.I.: 2.34-18.6). Conclusion HD had the greatest influence on TLR after PES even though risk factors were well controlled. It is necessary to develop new PCI techniques and stents that are useful for HD patients.
著者
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Moriguchi Masahiko
Department Of Cardio-angiology Kitasato University School Of Medicine
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Inomata Takayuki
Department Of Cardio-angiology Kitasato University School Of Medicine
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Fukuda Naoto
Department Of Surgery Keihin General Hospital
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Shinagawa Hisahito
Department Of Cardio-angiology Kitasato University School Of Medicine
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Soma Kazui
Department Of Critical Care And Emergency Kitasato University School Of Medicine
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Imaki Ryuta
Department Of Angio-cardiology Kitasato University School Of Medicine
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Izumi Tohru
Department Of Angio-cardiology Kitasato University School Of Medicine
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Shimohama Takao
Department Of Angio-cardiology Kitasato University School Of Medicine
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Takeuchi Ichiro
Department Of Angio-cardiology Kitasato University School Of Medicine
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Tojo Taiki
Department Of Angio-cardiology Kitasato University School Of Medicine
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Aoyama Naoyoshi
Department Of Angio-cardiology Kitasato University School Of Medicine
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Fukaya Hidehira
Department of Angio-Cardiology, Kitasato University School of Medicine
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Soma Kazui
Department of Emergency & Critical Care Medicine, Kitasato University School of Medicine
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Fukuda Naoto
Department of Cardio-Angiology, Kitasato University School of Medicine
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