Patients with renal failure and CAD

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I just posted a review of two articles about the treatment of Coronary Artery Disease in patients with kidney failure.

The more I read about results of Stent treatment for CAD, the more I learn about situations where it doesn’t work as well as it should. In particular this is the case in Diabetes, Renal failure and patients with impaired heart function, as well as in patient with extensive CAD.
Notable and significant exceptions are patients with Acute Coronary Syndrome (ACS), and ST Elevation Myocardial Infarction (STEMI).

In almost all other situations, in comparison with Coronary Bypass Surgery, even the newer Stents (whether with or without drug eluting capacity) show a consistently poorer outcome, despite a constant flow of new publications trying to prove otherwise.

These outcome differences become even more obvious in the more complicated or sicker patients. It is not as if CABG is a panacea for good results. Like any operation, successful treatment depends on the patient’s condition, the surgeon’s skills and a host of other factors.

In the “real world” most patients undergo Percutaneous Coronary Interventions (PCI) as primary treatment for CAD. PCI has been promoted as the safer alternative, precisely to avoid those “dangerous” operations. This includes the conditions described in this blog, as well as those that would benefit from Optimal Medical Therapy (OMT).

Treatment with PCI offers significant benefits to patients if used properly. Once treated with PCI, especially with the new Drug Eluting Stents (DES), patients should be aware that this includes a 10% or more repeat procedure rate, expensive medications, discontinuation of which is dangerous.

CABG has its own “built-in” risk of complications that include stroke, infection, graft failure and atrial fibrillation. A successful CABG however, offers a long term solution that is for the most part very well tolerated and easily managed, allowing patients to go on with their lives without the “sword of CAD” hanging over their head,

Dr T

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