RESUMO
OBJECTIVE: We sought to describe a technique for ultra-low-contrast angiography (ULCA) in patients with advanced chronic kidney disease (CKD) and previous coronary artery bypass surgery (CABG). BACKGROUND: Patients with advanced CKD and previous CABG are at high risk of developing contrast-induced nephropathy (CIN) because of the additional contrast often required to identify bypass grafts. Apart from hydration, reduced contrast administration is the only established method to minimize the risk of CIN. PATIENTS AND METHODS: Ten patients underwent ULCA, whereby an intracoronary injection of saline and coronary guidewires were used instead of test injections of contrast for engagement of bypass grafts with catheters. Estimated glomerular filtration rate (eGFR) before and 30 days following angiography were recorded as was the need for renal replacement therapy 1 year after the procedure. RESULTS: All patients completed a diagnostic angiogram without complications. The median volume of contrast delivered was 13.5 ml (interquartile range: 10.5-17.8). The median eGFR was 18.3 ml/min/1.73 m (interquartile range: 16.5-28.2). There was no statistically significant difference in eGFR before the procedure and 30 days after the procedure (P=0.79). No patient required dialysis 30 days after the procedure. Two patients required initiation of dialysis at 1 year after the procedure. CONCLUSION: In patients with advanced CKD and previous CABG, ULCA may be performed with high procedural success and without complications, minimizing the risk of CIN in these high-risk patients.
Assuntos
Injúria Renal Aguda/prevenção & controle , Meios de Contraste/administração & dosagem , Angiografia Coronária , Ponte de Artéria Coronária , Taxa de Filtração Glomerular/efeitos dos fármacos , Rim/efeitos dos fármacos , Insuficiência Renal Crônica/complicações , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/fisiopatologia , Idoso , Meios de Contraste/efeitos adversos , Angiografia Coronária/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Feminino , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Drug-eluting stents (DESs) have improved clinical outcomes of patients undergoing percutaneous coronary intervention (PCI). Nevertheless, adverse events related to previously treated lesion still occur. We sought to evaluate the incidence and predictors of target lesion failure (TLF) in patients undergoing contemporary DES implantation. METHODS: Patient-level data from 6 prospective, randomized trials were pooled, and DES treatment outcomes were analyzed at up to 5â¯years. Primary outcome was TLF (cardiac death, target lesion revascularization, or target vessel myocardial infarction). Cox proportional-hazards model was used to identify predictors of TLF. RESULTS: Overall, 10,072 patients were included in the analysis. TLF rate was 1.7%, 4.3%, and 11.9% at 30â¯days, 1â¯year, and 5â¯years, respectively. The only independent predictor of TLF at 30â¯days was stent length (hazard ratio [HR] 1.017, 95% CI 1.011-1.024, Pâ¯<â¯.0001). Moderate/severe calcification, stent length and post procedural diameter sthenosis were predictors between 30â¯days to 1â¯year but not at 1 to 5â¯years. Reference vessel diameter was the only lesion-related predictor at 5â¯years (Pâ¯=â¯.003). Clinical predictors of TLF between 30â¯days and 1â¯year were diabetes and hypertension (Pâ¯<â¯.01 for both), and between 1 and 5â¯years, diabetes (HR 1.40, 95% CI 1.13-1.73, Pâ¯=â¯.002), prior coronary artery bypass grafting (HR 2.52, 95% CI 1.92-3.30, Pâ¯<â¯.0001), and prior PCI (HR 1.29, 95% CI 1.02-1.64, Pâ¯=â¯.04) predicted TLF. CONCLUSIONS: Predictors of TLF vary in the early, late, and very late postprocedural periods. Reference vessel diameter was the only lesion-related predictor of long-term TLF; clinical predictors were diabetes, prior coronary artery bypass grafting, and prior PCI.
Assuntos
Reestenose Coronária/terapia , Stents Farmacológicos/estatística & dados numéricos , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/estatística & dados numéricos , Falha de Prótese , Antineoplásicos/uso terapêutico , Everolimo/uso terapêutico , Feminino , Cardiopatias/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Paclitaxel/uso terapêutico , Intervenção Coronária Percutânea/métodos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Tempo , Falha de TratamentoRESUMO
Intravascular imaging plays a key role in optimizing outcomes for percutaneous coronary intervention (PCI). Optical coherence tomography (OCT) utilizes a user-friendly interface and provides high-resolution images. OCT can be used as part of daily practice in all stages of a coronary intervention: baseline lesion assessment, stent selection, and stent optimization. Incorporating a standardized, algorithmic approach when using OCT allows for precision PCI.