Coronary revascularization in end-stage renal disease

Advanced coronary artery disease and acute cardiac events are the most common causes of death in patients with end-stage renal disease. Because of their heightened risk, end-stage renal disease patients are frequently referred for coronary revascularization. However, these patients are almost always excluded from trials examining various innovations in medical and revascularization interventions for cardiovascular conditions. Extrapolation of trial conclusions regarding dialysis patients can be misleading because the risk-benefit ratios of various interventions in this patient population can be markedly different. Thus, clinical decisions regarding the need for (and type of) coronary revascularization are based on retrospective outcome analyses from various databases. This article reviews the data available in the literature on the morbidity, mortality, and outcomes of dialysis patients undergoing surgical or percutaneous revascularization, particularly with the addition of drug-eluting stents to the available therapeutic options.