말기신부전 환자에서 시행한 관상동맥 조영술 소견과 치료에 대한 고찰

Abstract

Background - Disease of the heart remains the leading cause of death in patients treated for endstage renal disease(ESRD). In contrast to person with normal renal function, coronary risk factors or indicators could not yet clearly be defined in renal insufficiency. The aim of this study is to elucidate whether conventional risk factors are valid predictors of coronary artery disease(CAD) in ESRD patients and to examine the therapeutic outcome of percutaneous transluminal coronary angioplasty(PTCA) and coronary artery bypass graft(CABG) in chronic dialysis patients. Methods: Between 1997 and 1999, 44 ESRD patients were perfomed by echocardiography and coronary angiography. Results: 31 patients showed positive results in coronary angiography. In patients with CAD, there were statistically significantly older(45.4 vs 60.6 yrs), had higher LP(a> level(18.0 vs 37.5 mg/dL), lower HDL cholesterol level(42.5 vs 33.6 mg/dL), higher BMI (20.7 vs 22.6), and lesser degree of ejection fraction on echocardiography(58.6Yo vs 42.8Yo). And there were more patients who had DM(30.8 vs 64.5Fo) and previous myocardial infarction(MI) histories(7.796 vs 38.7 96) in CAD group. Logistic regression analysis suggested that old age, high Lp(a), and previous MI history could be risk factors for coronary artery disease in ESRD patients. Among the 31 patients had CAD, 10 in HD and 3 in CAPD group experienced PTCA, and another 2 in HD and 4 in CAPD group experienced CABG. Treatment modality and mortality were not different between the two groups. Follow up angiography were performed in 4 HD patients, and 2 of them had restenosis of previously involved vessels. Conclusion: Old age, previous MI history and high Lp(a) are independent risk factors for the presence of CAD in ESRD patients.