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Recanalization of Chronic Total Occlusions in Patients With vs Without Chronic Kidney Disease: The Impact of Contrast-Induced Acute Kidney Injury.
Can J Cardiol 2018; 34(10):1275-1282CJ

Abstract

BACKGROUND

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with high contrast volumes, which can be particularly deleterious in patients with chronic kidney disease (CKD). We aimed to study the outcomes of CTO PCI in subjects with vs without CKD, and the impact of contrast-induced acute kidney injury (CI-AKI).

METHODS

This multicentre registry included patients who underwent CTO PCI at 5 centres. CI-AKI was defined as an increase in serum creatinine ≥0.3 mg/dL or ≥50% from baseline within 72 hours. Study endpoints were CI-AKI, and all-cause death and target-lesion failure (TLF: cardiac death, target-vessel myocardial infarction, or target-lesion revascularization) on follow-up.

RESULTS

Study population included 1092 patients (CKD n = 214, no CKD n = 878). Patients with CKD had more comorbidities and adverse angiographic features, compared with subjects without CKD. Patients with CKD experienced lower technical (79% vs 87%, P = 0.001) and procedural (79% vs 86%, P = 0.008) success rates. CI-AKI developed in 9.1% (CKD 15.0% vs no CKD 7.8%, P = 0.001). Rates of in-hospital need for dialysis were 0.5% vs 0%, respectively (P = 0.03). Patients with CKD had higher 24-month rates of all-cause death (11.2% vs 2.7%, P < 0.001) and new need for dialysis (1.1% vs 0.1%, P = 0.03), but similar TLF rates (12.4% vs 10.5%, P = 0.47). CI-AKI was not an independent predictor of all-cause death or TLF.

CONCLUSIONS

CTO PCI in patients with CKD is associated with lower success rates and higher incidence of CI-AKI. The need for dialysis both in-hospital and on follow-up is infrequent. Although patients with CKD suffer higher rates of all-cause death, TLF rates are similar regardless of CKD status.

Authors+Show Affiliations

Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. Electronic address: azzalini.lorenzo@hsr.it.Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain.Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.Department of Cardiology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan.Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain.Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain.Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium.Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain.Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

30269828

Citation

Azzalini, Lorenzo, et al. "Recanalization of Chronic Total Occlusions in Patients With Vs Without Chronic Kidney Disease: the Impact of Contrast-Induced Acute Kidney Injury." The Canadian Journal of Cardiology, vol. 34, no. 10, 2018, pp. 1275-1282.
Azzalini L, Ojeda S, Demir OM, et al. Recanalization of Chronic Total Occlusions in Patients With vs Without Chronic Kidney Disease: The Impact of Contrast-Induced Acute Kidney Injury. Can J Cardiol. 2018;34(10):1275-1282.
Azzalini, L., Ojeda, S., Demir, O. M., Dens, J., Tanabe, M., La Manna, A., ... Colombo, A. (2018). Recanalization of Chronic Total Occlusions in Patients With vs Without Chronic Kidney Disease: The Impact of Contrast-Induced Acute Kidney Injury. The Canadian Journal of Cardiology, 34(10), pp. 1275-1282. doi:10.1016/j.cjca.2018.07.012.
Azzalini L, et al. Recanalization of Chronic Total Occlusions in Patients With Vs Without Chronic Kidney Disease: the Impact of Contrast-Induced Acute Kidney Injury. Can J Cardiol. 2018;34(10):1275-1282. PubMed PMID: 30269828.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recanalization of Chronic Total Occlusions in Patients With vs Without Chronic Kidney Disease: The Impact of Contrast-Induced Acute Kidney Injury. AU - Azzalini,Lorenzo, AU - Ojeda,Soledad, AU - Demir,Ozan M, AU - Dens,Joseph, AU - Tanabe,Masaki, AU - La Manna,Alessio, AU - Benincasa,Susanna, AU - Bellini,Barbara, AU - Poletti,Enrico, AU - Maccagni,Davide, AU - Hidalgo,Francisco, AU - Chavarría,Jorge, AU - Maeremans,Joren, AU - Gravina,Giacomo, AU - Miccichè,Eligio, AU - D'Agosta,Guido, AU - Venuti,Giuseppe, AU - Tamburino,Corrado, AU - Pan,Manuel, AU - Carlino,Mauro, AU - Colombo,Antonio, Y1 - 2018/07/19/ PY - 2018/05/09/received PY - 2018/07/14/revised PY - 2018/07/15/accepted PY - 2018/10/2/entrez PY - 2018/10/3/pubmed PY - 2019/6/7/medline SP - 1275 EP - 1282 JF - The Canadian journal of cardiology JO - Can J Cardiol VL - 34 IS - 10 N2 - BACKGROUND: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with high contrast volumes, which can be particularly deleterious in patients with chronic kidney disease (CKD). We aimed to study the outcomes of CTO PCI in subjects with vs without CKD, and the impact of contrast-induced acute kidney injury (CI-AKI). METHODS: This multicentre registry included patients who underwent CTO PCI at 5 centres. CI-AKI was defined as an increase in serum creatinine ≥0.3 mg/dL or ≥50% from baseline within 72 hours. Study endpoints were CI-AKI, and all-cause death and target-lesion failure (TLF: cardiac death, target-vessel myocardial infarction, or target-lesion revascularization) on follow-up. RESULTS: Study population included 1092 patients (CKD n = 214, no CKD n = 878). Patients with CKD had more comorbidities and adverse angiographic features, compared with subjects without CKD. Patients with CKD experienced lower technical (79% vs 87%, P = 0.001) and procedural (79% vs 86%, P = 0.008) success rates. CI-AKI developed in 9.1% (CKD 15.0% vs no CKD 7.8%, P = 0.001). Rates of in-hospital need for dialysis were 0.5% vs 0%, respectively (P = 0.03). Patients with CKD had higher 24-month rates of all-cause death (11.2% vs 2.7%, P < 0.001) and new need for dialysis (1.1% vs 0.1%, P = 0.03), but similar TLF rates (12.4% vs 10.5%, P = 0.47). CI-AKI was not an independent predictor of all-cause death or TLF. CONCLUSIONS: CTO PCI in patients with CKD is associated with lower success rates and higher incidence of CI-AKI. The need for dialysis both in-hospital and on follow-up is infrequent. Although patients with CKD suffer higher rates of all-cause death, TLF rates are similar regardless of CKD status. SN - 1916-7075 UR - https://www.unboundmedicine.com/medline/citation/30269828/Recanalization_of_Chronic_Total_Occlusions_in_Patients_With_vs_Without_Chronic_Kidney_Disease:_The_Impact_of_Contrast_Induced_Acute_Kidney_Injury_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0828-282X(18)30515-4 DB - PRIME DP - Unbound Medicine ER -