According to the National Kidney Foundation, more than 20 million Americans (one in nine adults) have chronic kidney disease (CKD). Many of these people also have heart disease and undergo percutaneous coronary intervention (PCI), in which angioplasty and stenting are employed to widen narrowed blood vessels. CKD places these patients at increased risk for restenosis, the renarrowing of blood vessels after PCI.
At a poster session today at the American College of Cardiology's 54th Annual Scientific Sessions in Orlando, Emory biostatistician Jovonne K. Foster reported on Emory research which shows the drug cilostazol can significantly help reduce restenosis in patients with heart disease and CKD.
"Even a small reduction in kidney function is associated with a higher rate of cardiovascular events. There is a greater risk of heart disease as kidney disease worsens" says Claudine T. Jurkovitz, MD, MPH, Assistant Professor of Cardiology at Emory School of Medicine and one of the authors of the research presented today. "People with CKD have a higher incidence of restenosis and their risk of death after percutaneous coronary intervention also is increased."
The Cilostazol for RESTenosis (CREST) trial had previously shown that patients treated with cilostazol after PCI and stenting had a significantly lower rate of restenosis than patients treated with placebo, but these findings did not evaluate the effect of cilostazol on restenosis in patients with CKD. To that end, Emory researchers analyzed a total of 705 patients enrolled in CREST, using creatinine levels to calculate glomerular filtration rates to determine which patients had CKD. They then documented restenosis in this population, using six month post PCI angiograms. The results showed that patients with CKD treated with placebo had a 36.6 percent in-segment restenosis rate while those treated with cilostazol had only a 15.2 percent restenosis rate.
"We conclude that CKD patients may benefit from treatment with cilostazol after PCI. Our findings could be of significant public health importance, considering the high prevalence of CKD in the US and the poor long-term outcome of these patients following PCI," says Dr. Jurkovitz.
The Emory team of researchers also included Karen M Parker, BS; Grant T Anderson, BA; Paul Kolm, Ph.D; Nancy V Murrah, RN,BSN; Ziyad Ghazzal, MD, William S. Weintraub, MD, and John S Douglas Jr, MD. Dr. Douglas disclosed a commercial relationship with Otsuka America Pharmaceutical, Inc.