ABSTRACT
This study aims to elucidate 1-year clinical outcomes using this technique for patients with stage 4 or 5 advanced chronic kidney disease (CKD). Research has proven that imaging-guided percutaneous coronary intervention (PCI) reduces contrast volume significantly; however, only short-term clinical benefits have been reported. Minimum-contrast (MINICON) studies are based on the registry design pattern to enroll PCI results in patients with advanced CKD stage 4 or 5 comorbid with coronary artery disease. We excluded cases of emergency PCI or maintenance dialysis from this study. In this study, we compared the intravascular ultrasound (IVUS)-guided MINICON PCI group (n = 98) with the angiography-guided standard PCI group (n = 86). Enrollment of the MINICON studies started in 2006. Before 2012, IVUS-guided MINICON PCI was performed only in 14% (stage 1), but it was 100% after 2012 (stage 2). The enrollment finished in 2016. The IVUS-guided MINICON PCI group exhibited a significantly reduced contrast volume (22 ± 20 vs. 130 ± 105 mL; P < 0.0001) and contrast-induced acute kidney injury (CI-AKI; 2% vs. 15%; P = 0.001). The PCI success rate was similarly high (100% vs. 99%; P = 0.35). At 1 year (follow-up rate, 100%), we observed less induction of renal replacement therapy (RRT; 2.7% vs. 13.6%; P = 0.01), but all-cause mortality or myocardial infarction was similar in both groups. The IVUS-guided MINICON PCI reduces CI-AKI significantly and induction of RRT at 1 year in patients with stage 4 or 5 advanced CKD.
Subject(s)
Contrast Media/administration & dosage , Coronary Angiography/methods , Coronary Artery Disease/surgery , Percutaneous Coronary Intervention/methods , Renal Insufficiency, Chronic/complications , Surgery, Computer-Assisted/methods , Ultrasonography, Interventional/methods , Aged , Coronary Artery Disease/diagnosis , Female , Follow-Up Studies , Humans , Male , Prospective Studies , Renal Insufficiency, Chronic/diagnosis , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
Extending the method of Robinson and Wolczek, we show that in order to avoid a breakdown of general covariance and gauge invariance at the quantum level the total flux of charge and energy in each outgoing partial wave of a charged quantum field in a Reissner-Nordström black hole background must be equal to that of a (1 + 1)-dimensional blackbody at the Hawking temperature with the appropriate chemical potential.
