High parathyroid hormone (PTH) levels in patients on dialysis are likely to increase intracoronary calcification and cause inadequate stent expansion in those who undergo percutaneous coronary intervention (PCI) for coronary artery disease (CAD).
Researchers revealed an association between high intact PTH (iPTH) levels and an increased risk for major adverse cardiac and cerebrovascular events (MACCE) and death.
Takahiro Kobayashi, MD, of Chiba University Graduate School of Medicine in Chiba, Japan, and colleagues studied 116 patients on dialysis who underwent PCI for CAD with intravascular ultrasound (IVUS) guidance. The investigators divided patients into a 2 groups based on their median serum iPTH level: a low iPTH group (less than 132 pg/mL; 59 patients) and a high iPTH group (132 pg/mL or higher; 57 patients).
Preprocedure calcification scores determined using grayscale IVUS in the target lesions were significantly higher in the group with higher iPTH levels, Dr Kobayashi and colleagues reported in the Circulation Journal. Following PCI, the high iPTH group had a significantly lower expansion index (0.6 vs 0.7) and stent symmetry index (0.5 vs 0.7) compared with the low iPTH group. In addition, the incidence of MACCE and death within 3 years was 33.9% and 32.2%, respectively, in the low iPTH group compared with 60.7% and 54.4%, respectively, in the high iPTH group.
“The serum iPTH level can be a surrogate marker of short- and long-term clinical outcomes of dialysis patients with CAD undergoing PCI,” the investigators wrote. “The strict management of secondary hyperparathyroidism, including phosphate binders, vitamin D derivatives, calcimimetics, and parathyroidectomy, may be necessary to improve prognosis in dialysis patients with CAD requiring PCI.”
Kobayashi T, Kitahara H, Kato K, Saito Y, Kobayashi Y. Impact of parathyroid hormone level on intracoronary calcification and short- and long-term outcomes in dialysis patients undergoing percutaneous coronary intervention. Circ J. Published online August 27, 2022. doi:10.1253/circj.CJ-22-0202