Management of Coronary Artery Disease in Patients with End-staged Chronic Kidney Disease: the Experience of Single Department

Zalina Kudzoeva ¹, Leo Bockeria ¹, Olga Bockeria ¹, Sripal Bangalore ², Michael Yarustovsky ¹, Karen Petrosyan ¹

¹ Bakoulev Scientific Center for CVS, Moscow, Russia; ² New York University School of Medicine,, New-York, USA;

Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–C

Abstract

Objective

Patients with chronic kidney disease (CKD) and coronary artery disease (CAD) have higher mortality rates. In general population, there has been a reduction in the mortality rates for CAD through the implementation of different interventions. No such trend has been observed in patients with end-stage CKD.

To assess treatment options for outcomes improvement in patients with CAD and end-staged CKD.

Methods

From January 2015 to October 2017 35 patients with end-staged CKD and CAD were hospitalized to the Bakulev center for cardiovascular surgery. All patients underwent stress imaging and coronary angiography for risk stratification and as a part of pre-transplant screening as well. According to coronary angiography results heart team approach was implemented for optimal management. FFR was used in 5 cases. 1 year results were analyzed: angina angina functional class, MI, death, repeat revascularization.

Results

19 patients had no obstructive CAD. In 5-FFR was used (mean FFR - 0.95, mean angina FC-1.14).

14 patients underwent PCI. Mean SS – 29.5. 8 patients had completed and 6 – uncompleted anatomical revascularization. Mean 1.4 vessels and 1.6 stents were placed per patient. Mean angina FC before procedure - 2.85, 1-year follow-up - 1.35.

2 patients underwent CABG. Mean SS – 38.5. 1 patient had completed and 1 – uncompleted anatomical revascularization. Mean 1.5 vessels and and 1.5 grafts were used per patient. Mean angina FC before procedure was 3, 1 year follow-up- 2. No MI, death, repeat revascularization were observed in 1 year follow-up in both groups.

Conclusion

Non-invasive stress testing and coronary angiography with FFR can be used to diagnose obstructive CAD in patients. Selected CKD patients with stable CAD can be managed with PCI and CABG with no increased procedure risk and outcomes compared to the general population. The optimal pre-transplant CAD screening and management approaches are still to be defined.