The objective of this investigation was to assess the acute and long-term outcome after coronary angioplasty in patients undergoing chronic hemodialysis. Previous studies have suggested a high incidence of restenosis after coronary angioplasty performed in patients with renal failure. Medical discharge abstracts for 8342 patients undergoing angioplasty during a 5-year period were searched to identify all coronary angioplasty procedures performed in patients undergoing chronic hemodialysis. Procedural and follow-up coronary angiograms were reviewed in a core angiographic laboratory. Hospital records and office visit notes were obtained to assess acute and long-term outcome. Twenty-one patients undergoing chronic hemodialysis had been treated by coronary angioplasty. The 9 men and 12 women had a mean age of 59 +/- 10 years (range 37 to 78 years) and had been undergoing hemodialysis for 6.2 +/- 6.4 years (range 1 to 19 years). Procedural success was achieved in 12 (57%) of 21 patients. Three (14%) patients died; 4 suffered nonfatal myocardial infarctions (19%); 1 (5%) required emergency bypass surgery; and 1 (5%) had abrupt vessel closure without complications. Of the 15 (71%) patients who were discharged with a patent angioplasty vessel, 4 (27%) died and 9 (60%) had recurrence of angina within 1 year. Of 9 patients with recurrent angina, 7 underwent a second angiography, and all showed evidence of restenosis at the previous angioplasty site. The results of coronary angioplasty in these 21 hemodialysis patients suggest a high rate of acute complications and poor long-term prognosis in this subgroup. Other strategies for revascularization should be considered for these patients.