và nó sẽ tạo điều kiện thuận lợi cho việc thiết kế thử nghiệm lâm sàng quy mô lớn nhắm mục tiêu các bệnh nhân bị suy thận. Một nghiên cứu tiềm năng của kết quả PCI ở bệnh nhân thận giai đoạn cuối là vô cùng cần thiết, như chúng tôi vẫn không có một dự toán chính xác tỷ lệ | 44 Chapter 2 at relatively modest cost and it would facilitate the design of large-scale clinical trials targeting patients with renal failure. A prospective study of PCI outcome in ESRD patients is sorely needed as we still do not have an accurate estimation of restenosis rates after PCI in dialysis patients and the accuracy of noninvasive detection of restenosis . Such a study would ideally include a prospective cohort of at least several hundred patients undergoing noninvasive stress imaging before angiography quantitative coronary angiography measurement of fractional flow reserve and perhaps IVUS intravascular ultrasound at the time of PCI and importantly repeat noninvasive stress imaging and quantitative coronary angiography and IVUS in all patients at restenosis-appropriate time intervals . 36 months and at 1 year. In a more ambitious trial promising therapies such as drug-eluting stents could be compared to conventional treatments. Data pertaining to the safety and efficacy of standard adjunctive pharmacologic therapy are virtually nonexistent in ESRD patients. Outcome data on glycoprotein IIb IIIa inhibitors would be an important part of the proposed interventional registry for PCI in renal failure but clinical trials of these agents targeting patients with renal failure would be particularly desirable. The role of contrast-mediated nephropathy for adverse outcome and its prevention perhaps with combination therapy including acetylcysteine and fenoldopam is another potential area for clinical trials in patients with chronic renal failure. Finally there may be better alternatives to PCI for coronary revascularization in dialysis patients. The ultimate clinical trial may be a prospective comparison of PCI perhaps drug-eluting stents and other effective adjunctive pharmacologic agents and surgical coronary revascularization employing arterial conduits and recent advances in surgical techniques including off-pump CAB surgery . There may be other more .
