Original title: Post-procedural Hemodiafiltration in Acute Coronary Síndrome Patients UIT Associated Renal and Cardiac Dysfunction unfergoing Urgent and Emergency Coronary Angiography. Reference: Giancarlo Marenzi, et al. Catherization and Cardiovascular Interention 2015 85:345-351

The association between acute coronary syndrome (ACS) and severe renal and cardiac dysfunction lowers survival. There is little information as to the best strategy to treat this group of patients. The study included 60 ACS patients (with or without ST elevation) with severe renal dysfunction (≤30 ml/min/1.73 m2) and ventricular dysfunction (FEY ≤40%), undergoing PCI. 30 patients received hemodiafiltration (HD) within 3 hours after procedure.

Mehran score was 14, glomerular filtration was 22±6 ml/min and ejection fraction was 31±8%. Except for diabetes, more frequent in the HD group, the rest of characteristics were similar. The HD group also saw less in hospital complications and an 8 fold lower mortality (3% vs. 23% p=0.05). 

At discharge, both groups presented similar creatinine values and no patient required definite dialysis. At one year follow up, mortality was in favor of HD (10% vs. 53% p<0.001), two patients in the HD group and one in the control group required definite dialysis.

Conclusion 

This pilot study suggests that in ACS patients with cardiac and renal failure, aggressive treatment with post procedural prophylactic HD was associated with better survival.

Comment

It has been shown that this group presents more complications including more bleeding. This pilot study showed that prophylactic post procedural HD is beneficial, it lowers in hospital mortality and mortality at 12 months. Until further breakthroughs or alternative strategies, this is the strategy we should use to treat these patients. 

Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation – Argentina

Carlos Fava