2011年7月
Impact of Diabetes on Cardiovascular Outcomes in Hemodialysis Patients Undergoing Coronary Revascularization
CIRCULATION JOURNAL
- 巻
- 75
- 号
- 7
- 開始ページ
- 1616
- 終了ページ
- 1625
- 記述言語
- 英語
- 掲載種別
- 研究論文(学術雑誌)
- DOI
- 10.1253/circj.CJ-10-1235
- 出版者・発行元
- JAPANESE CIRCULATION SOC
Background: Among hemodialysis (HD) patients, those who have diabetes have poorer cardiovascular outcomes than non-diabetic patients, but the impact of diabetes on cardiovascular outcomes has not been fully elucidated in HD patients undergoing coronary revascularization.
Methods and Results: We identified 375 HD patients (203 diabetes, 172 non-diabetes) and 9,006 patients without HD (3,455 diabetes, 5,551 non-diabetes) in the database of the CREDO-Kyoto registry of patients undergoing their first coronary revascularization. In non-HD patients, significantly higher risks of death (10.8% vs. 7.7%, P<0.0001; adjusted hazard ratio (HR) 1.29, P<0.0001) and major adverse cardiovascular events (MACE), a composite of death, myocardial infarction and stroke (18.8% vs. 13.3%, P<0.0001; HR 1.36, P<0.0001) were seen in diabetic patients than in non-diabetic patients through 4-year follow-up. Analysis in HD patients showed that the duration of HD before first coronary revascularization was significantly shorter in diabetic patients than in non-diabetic patients (median interval: 858 vs. 2,216 days, P<0.0001). In contrast to the results in non-HD patients, the risks of death (41.9% vs. 39.1%, P=0.75; HR 0.98, P=0.93) and MACE (45.6% vs. 45.8%, P=0.83; HR 0.87, P=0.50) after first revascularization were comparable between diabetic and non-diabetic HD patients. There were significant interactions between HD and diabetes for death and for MACE.
Conclusions: HD patients who require coronary revascularization have extremely poor outcomes irrespective of concomitant diabetes. (Circ J 2011; 75: 1616-1625)
Methods and Results: We identified 375 HD patients (203 diabetes, 172 non-diabetes) and 9,006 patients without HD (3,455 diabetes, 5,551 non-diabetes) in the database of the CREDO-Kyoto registry of patients undergoing their first coronary revascularization. In non-HD patients, significantly higher risks of death (10.8% vs. 7.7%, P<0.0001; adjusted hazard ratio (HR) 1.29, P<0.0001) and major adverse cardiovascular events (MACE), a composite of death, myocardial infarction and stroke (18.8% vs. 13.3%, P<0.0001; HR 1.36, P<0.0001) were seen in diabetic patients than in non-diabetic patients through 4-year follow-up. Analysis in HD patients showed that the duration of HD before first coronary revascularization was significantly shorter in diabetic patients than in non-diabetic patients (median interval: 858 vs. 2,216 days, P<0.0001). In contrast to the results in non-HD patients, the risks of death (41.9% vs. 39.1%, P=0.75; HR 0.98, P=0.93) and MACE (45.6% vs. 45.8%, P=0.83; HR 0.87, P=0.50) after first revascularization were comparable between diabetic and non-diabetic HD patients. There were significant interactions between HD and diabetes for death and for MACE.
Conclusions: HD patients who require coronary revascularization have extremely poor outcomes irrespective of concomitant diabetes. (Circ J 2011; 75: 1616-1625)
- リンク情報
-
- DOI
- https://doi.org/10.1253/circj.CJ-10-1235
- CiNii Articles
- http://ci.nii.ac.jp/naid/10029126458
- PubMed
- https://www.ncbi.nlm.nih.gov/pubmed/21532182
- Web of Science
- https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000292342600017&DestApp=WOS_CPL
- ID情報
-
- DOI : 10.1253/circj.CJ-10-1235
- ISSN : 1346-9843
- CiNii Articles ID : 10029126458
- PubMed ID : 21532182
- Web of Science ID : WOS:000292342600017