Treatment outcomes for ischemic heart disease in dialysis-dependent patients

Yeates, Alexander, Hawley, Carmel, Mundy, Julie, Pinto, Nigel, Haluska, Brian and Shah, Pallav (2012) Treatment outcomes for ischemic heart disease in dialysis-dependent patients. Asian Cardiovascular and Thoracic Annals, 20 3: 281-291. doi:10.1177/0218492312437383

Author Yeates, Alexander
Hawley, Carmel
Mundy, Julie
Pinto, Nigel
Haluska, Brian
Shah, Pallav
Title Treatment outcomes for ischemic heart disease in dialysis-dependent patients
Journal name Asian Cardiovascular and Thoracic Annals   Check publisher's open access policy
ISSN 0218-4923
Publication date 2012-06
Sub-type Article (original research)
DOI 10.1177/0218492312437383
Open Access Status
Volume 20
Issue 3
Start page 281
End page 291
Total pages 11
Place of publication London, United Kingdom
Publisher Sage Publications
Language eng
Subject 2705 Cardiology and Cardiovascular Medicine
2746 Surgery
2740 Pulmonary and Respiratory Medicine
2700 Medicine
Formatted abstract
Objective: To compare outcomes following intervention in dialysis-dependent patients with ischemic heart disease.

Background: Ischemic heart disease is a major cause of mortality in dialysis-dependent patients. Coronary revascu-larization and medical modification to relieve symptoms is common, however, there is no clear consensus regarding optimal treatment.

Method: Ninety dialysis-dependent patients with ischemic heart disease were prospectively assessed between 1999 and 2009, with a median follow-up of 24 months; 35 received best medical management, 31 had percutaneous coronary angioplasty and stenting, and 24 had coronary artery bypass grafting.

Results: By multivariate analysis, higher body mass index and lower logistic EuroSCORE were associated with having either procedure compared to medical management. Using the time-to-event Kaplan-Meier method, both stenting and coronary bypass grafting had lower risks of an adverse outcome than best medical management. Mortality was 40/90 (44.4%). Multivariate predictors of mortality were smoking and a logistic EuroSCORE of 7-14. Overall mortality was not different among groups, however, the stent group had a survival advantage at 30-days and 1-year compared to the coronary bypass group. Composite median survival was 52.3 months. SF-36 questionnaires showed quality of life after bypass grafting was significantly better than medical management or stenting. Physical function was better after bypass grafting compared to medical management or stenting.

Conclusion: Dialysis-dependent patients with ischemic heart disease have poor survival despite intervention. Coronary artery bypass achieves fewer composite adverse events and better quality of life than stenting. Symptoms and coronary anatomy should dictate treatment decisions in dialysis-dependent patients.
Keyword Coronary artery bypass
Coronary disease
Kidney diseases
Myocardial revascularization
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: Scopus Citation Count Cited 6 times in Scopus Article | Citations
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