RESUMO
BACKGROUND: Hemodialysis (HD) patients are reported to show poor clinical outcomes after percutaneous coronary intervention (PCI) with sirolimus-eluting stent (SES) compared with non-HD patients and their long-term prognosis remains unclear. METHODSâANDâRESULTS: We prospectively enrolled 489 consecutive patients undergoing PCI with SES and performed a retrospective analysis focusing on HD patients. Median follow-up was 7.0 years (interquartile range, 4.2-7.9) and the follow-up rate was 100%. At the 7-year follow-up, the cumulative incidences of all-cause death, target lesion revascularization (TLR) and major adverse cardiac events (MACE) were significantly higher in HD patients than in non-HD patients (HD vs. non-HD=34.7% vs. 9.6%, 42.6% vs. 10.2% and 75.3% vs. 24.4%, respectively; log-rank P<0.001). Cox-proportional hazard analysis revealed that independent predictors of all-cause death were HD (hazard ratio [HR] 2.88, 95% confidence interval [CI]: 1.39-6.00), insulin-treated diabetes mellitus (HR 2.19, 95% CI: 1.17-4.11), heart failure (HR 2.58, 95% CI: 1.25-5.32) and older age (HR 1.06/1-age, 95% CI: 1.02-1.10). Moreover, HD was an independent predictor of TLR (HR 3.63, 95% CI: 1.85-7.11) and MACE (HR 3.54, 95% CI: 2.19-5.73). CONCLUSIONS: In the present study, Japanese HD patients undergoing PCI with SES showed poorer long-term clinical outcomes than non-HD patients. HD was a strong predictor of long-term adverse events after SES implantation.
Assuntos
Doença da Artéria Coronariana , Stents Farmacológicos/efeitos adversos , Intervenção Coronária Percutânea , Diálise Renal , Sirolimo , Fatores Etários , Idoso , Povo Asiático , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sirolimo/administração & dosagem , Sirolimo/efeitos adversos , Taxa de SobrevidaRESUMO
Tissue-specific gene deletion by the Cre-loxp system is a powerful tool to investigate the roles of specific genes. To determine the specificity and efficiency of the Cre-mediated recombination under the control of the human smooth muscle alpha-actin promoter, we mated SMalphaA-Cre mice and R26R reporter mice. Cre-mediated recombination was observed in visceral and vascular smooth muscle cells. Partial recombination was also found in heart and musculoskeletal connective tissues. Highly efficient recombination was found in cranial sutures. Hence, we propose that SMalphaA-Cre mice are good tool for conditionally deleting gene function in the cranial suture in addition to smooth muscle cells.