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CLINICAL STUDY

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

Luis Gruberg, MD^*, Ron Waksman, MD, FACC^*, Andrew E. Ajani, MD^*, Han-Soo Kim, MD^*, R. Larry White, MD, Ellen Pinnow, MS^*, Regina Deible, RN^*, Lowell F. Satler, MD, FACC^*, Augusto D. Pichard, MD, FACC^*, Kenneth K. Kent, MD, PhD, FACC^* and Joseph Lindsay, Jr, MD, FACC^*

^* Washington Hospital Center, Washington, D.C., USA
Washington Cancer Institute at the Washington Hospital Center, Washington, D.C., USA

Manuscript received March 9, 2001; revised manuscript received June 4, 2001, accepted June 25, 2001.

Reprint requests and correspondence: Dr. Ron Waksman, Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, D.C. 20010
rxw8{at}mhg.edu

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 population for accelerated atherosclerotic cardiovascular disease and for restenosis after percutaneous coronary intervention. Previous studies have shown the effectiveness of both beta and gamma radiation in preventing recurrent restenosis 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 recurrence of in-stent restenosis in native coronaries and saphenous vein grafts.

RESULTS

Patients with CRF were usually older, women, hypertensive and diabetic, with multivessel disease and with reduced left ventricular function. In-hospital outcome for patients with CRF was marred by a higher incidence of death, non–Q-wave myocardial infarction and major vascular and bleeding complications. At six-month follow-up, the mortality rate was higher in patients with CRF, 7.6% compared with 1.9% in non-CRF patients (p = 0.003). Restenosis, target lesion revascularization (TLR) and target vessel revascularization (TVR) rates were similar in the two groups. In patients with CRF, radiation 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, patients with renal dysfunction continued to have significantly higher in-hospital and six-month adverse outcomes.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CRF = chronic renal failure   CrCl = creatinine clearance   MI = myocardial infarction   PCI = percutaneous coronary intervention   TLR = target lesion revascularization   TVR = target vessel revascularization   WRIST = Washington Radiation for In-Stent Restenosis Trial

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