2009 年 21 巻 4 号 p. 245-253
It is believed that the rate of restenosis increases as chronic kidney disease (CKD) progresses. Although in random study of Sirolimus-eluting stent (SES) the rates of restenosis in patients on dialysis and those on non-dialysis have been compared, no comparison has been made among stages of CKD. We therefore compared the clinical results of percutaneous coronary intervention (PCI), using SES among stages of CKD. Of 1116 consecutive cases since the first PCI was performed using SES, 462 cases in which follow-up coronary angiography was performed in the remote phase were included in this study. These cases were classified into 6 groups, from stage 1 to stage 5 by degree of progression of CKD as well as dialysis, and clinical results were compared. Of the 462 cases in which follow-up coronary angiography in the remote phase was performed, 59.1% (273) of the cases were CKD stage 1, 14.9% (69) stage 2, 11.5% (53) stage 3, 2.2% (10) stage 4, 0% (0) stage 5, and 12.3% (57) were dialysis cases. In stage 1, the rate of restenosis was 8.1%, target lesion revascularization (TLR) 5.1% and target vessel revascularization (TVR) 6.6%; in stage 2, the rate of restenosis was 10.1%, TLR 8.7% and TVR 11.6%; in stage 3, the rate of restenosis was 7.5%, TLR 5.9% and TVR 11.6%; and in stage 4, the rate of restenosis, TLR and TVR were each 0%. In the dialysis group, the rate of restenosis was 31.6% (p < 0.0001), TLR 29.8% (p < 0.0001) and TVR 33.3% (p < 0.0001). When CKD stage 1 and the other stages were compared, no significant differences were observed in rate of restenosis, TLR and TVR except in the dialysis group. In the latter group, rate of restenosis, TLR and TVR were each significantly increased compared with CKD stage 1. The frequencies of restenosis, TLR and TVR in the remote phase of PCI using SES did not differ among stages of CKD.
