The effect of intracoronary radiation for the treatment of recurrent in-stent restenosis in patients with chronic renal failure

OBJECTIVES This study was designed to analyze the in-hospital and six-month clinical and angiographic outcomes of patients with chronic renal failure (CRF) treated with intracoronary radiation for the prevention of recurrence of in-stent restenosis. BACKGROUND Patients with CRF are at a higher risk than the general populati on for accelerated atherosclerotic cardiovascular disease and for restenosi s after percutaneous coronary intervention. Previous studies have shown the effectiveness of both beta and gamma radiation in preventing recurrent res tenosis in patients with in-stent restenosis. METHODS We studied the in-hospital and six-month clinical and angiographic outcomes of 118 patients with CRF and 481 consecutive patients without CRF who were treated with intracoronary radiation for the prevention of recurre nce of in-stent restenosis in native coronaries and saphenous vein grafts. RESULTS Patients with CRF were usually older, women, hypertensive and diabe tic, with multivessel disease and with reduced left ventricular function. I n-hospital outcome for patients with CRF was marred by a higher incidence o f death, non-Q-wave myocardial infarction and major vascular and bleeding c omplications. At six-month follow-up, the mortality rate was higher in pati ents with CRF, 7.6% compared with 1.9% in non-CRF patients (p = 0.003). Res tenosis, target lesion revascularization (TLR) and target vessel revascular ization (TVR) rates were similar in the two groups. In patients with CRF, r adiation therapy compared to placebo reduced restenosis (53.8% vs. 22.6%, p = 0.04), TLR (71.4% vs. 15.3%, p < 0.0001) and TVR (78.6% vs. 23.7%, p = 0 .0002). CONCLUSIONS Intracoronary radiation for the prevention of recurrence of in- stent restenosis achieved similar rates of restenosis and revascularization procedures in patients with and without CRF. Despite this benefit, patient s with renal dysfunction continued to have significantly higher in-hospital and six-month adverse outcomes. (C) 2001 by the American College of Cardio logy.