ABSTRACT
Coronary artery disease is the number one cause of death in patients with chronic kidney disease (CKD). However,patients with impaired renal function are much less likely than patients with normal renal function to undergo left heart catheterization and coronary intervention. Patients that do receive invasive strategies experience more bleeding and higher rates of ischemic events. In this review, we examine advances in percutaneous coronary intervention--including antiplatelet therapy and drug-eluting stents--and their impact on patients with CKD.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Disease/therapy , Renal Insufficiency, Chronic/complications , Angioplasty, Balloon, Coronary/adverse effects , Coronary Disease/complications , Drug-Eluting Stents , Fibrinolytic Agents/therapeutic use , Humans , Platelet Aggregation Inhibitors/therapeutic use , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitorsABSTRACT
Patients with chronic kidney disease (CKD) are considered to belong to the highest risk group for the development of cardiovascular events. These patients should be subject to aggressive risk-factor modification. However, management of coronary artery disease in patients with CKD can be uniquely challenging. Many of the medications used in the treatment and prevention of coronary artery disease are metabolized or excreted by the kidney. Thus, patients with CKD are more likely to experience adverse effects from any attempt to aggressively modify risk factors for coronary artery disease. Little is known regarding revascularization in patients with CKD. Patients with CKD may benefit from off-pump strategies during coronary artery bypass. Percutaneous coronary intervention in patients with CKD is associated with lower procedural success and increased peri-procedural myocardial infarction, ischemia, and target vessel revascularization. In this review, we discuss the unique challenges of managing coronary artery disease in patients with CKD.
Subject(s)
Coronary Artery Disease/therapy , Kidney Failure, Chronic/complications , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/therapy , Angioplasty, Balloon, Coronary , Coronary Artery Disease/blood , Coronary Artery Disease/complications , Dyslipidemias/complications , Dyslipidemias/drug therapy , Humans , Renal Insufficiency, Chronic/complicationsABSTRACT
Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular events. Echocardiography is an integral part of the evaluation of coronary artery disease. Chronic kidney disease has a predictable and unique effect on the myocardium and the epicardial circulation that may be detected by echocardiography. In particular dobutamine stress echocardiography has proved to be an invaluable tool in the detection of cardiovascular disease in patients with CKD. Here, we review the usefulness of echocardiography in the detection and evaluation of coronary artery disease in patients with CKD.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Echocardiography , Kidney Failure, Chronic/complications , Coronary Artery Disease/complications , Echocardiography, Stress , Humans , Kidney Failure, Chronic/therapyABSTRACT
Cardiac causes account for nearly half of all deaths in patients with end-stage renal disease (ESRD). Coronary artery disease (CAD) is present in 38% - 40% of patients starting dialysis. Both traditional and chronic kidney disease-related cardiovascular risk factors contribute to this high prevalence rate. In patients with ESRD, CAD--particularly acute myocardial infarction--is underdiagnosed. Dobutamine stress echocardiography and, to a lesser extent, stress myocardial perfusion imaging have proved useful in screening for CAD in such patients. Coronary artery calcium scoring is less useful. Acute myocardial infarction is associated with high short- and long-term mortality in dialysis patients. Cardiac troponin I appears to be more specific than cardiac troponin T or CK-MB in the diagnosis of acute myocardial infarction.
