Angiographic progression of coronary artery disease in patients with end-stage renal disease

Background. Patients with end-stage renal disease have an increased risk of developing coronary artery disease (CAD). The cardiovascular mortality of dialysis patients is 10-15 times higher compared with the general populatio n. The aim of our study was to evaluate the morphological progression of co ronary arteriosclerosis in this cardiovascular high-risk group by visual as sessment and quantitative coronary angiography. Methods and results. In 26 patients with chronic renal failure (age. 47+/-1 1 years: 15 male: duration of dialysis, 23 +/- 25 months) the severity of C AD and degree of coronary stenoses were assessed in two coronary angiograms after a mean follow-up interval of 30 +/- 15 months (12-60). Baseline angi ography revealed CAD in 13/22 patients (59%). The second angiography was pe rformed as screening procedure prior to renal transplantation (n=20) and/or as follow-up angiography after coronary angioplasty (n = 10). Visual asses sment showed a progression defined by the development of haemodynamically r elevant stenosis of > 50% luminal diameter in 13 patients. Quantitative ang iographic evaluation was performed in a total of 45 segments showing >25% n arrowing at the second angiogram. A progression (>15% luminal reduction) wa s found in 17 of 45 segments, a new lesion (initial luminal diameter < 20%) was detected in nine segments, resulting in progression or new lesion in 1 6 patients (62%). Patients with or without progression did not differ in ag e. duration of dialysis treatment, number of cardiovascular risk factors, o r serum total cholesterol and fibrinogen levels. After percutaneous translu minal coronary angioplasty (PTCA) a restenosis was seen in seven of 16 prim arily successfully dilated segments. After the second angiography, myocardi al revascularization was performed in eight patients (1 PTCA, 7 coronary ar tery bypass graft). Conclusions, Patients with end-stage renal disease have a high prevalence o f CAD. In line with the clinical course, CAD patients on maintenance dialys is undergo rapid angiographic progression of CAD, which results in a high r ate of subsequent myocardial revascularizations.