open access

Ahead of print
Original Article
Submitted: 2022-07-25
Accepted: 2022-11-12
Published online: 2022-12-29
Get Citation

Procedural outcomes of chronic total occlusion percutaneous coronary interventions in patients with acute kidney injury

Peter Tajti12, Mohamed Ayoub3, Abdelkrim Ahres2, Faridun Rahimi1, Michael Behnes4, Heinz-Joachim Buettner1, Franz-Josef Neumann1, Dirk Westermann1, Kambis Mashayekhi15
DOI: 10.5603/CJ.a2022.0121
·
Pubmed: 36588312
Affiliations
  1. Department of Interventional Cardiology, Cardiology, and Angiology II, University Heart Center Freiburg – Bad Krozingen, Germany
  2. Gottsegen György National Cardiovascular Institute – Budapest, Hungary
  3. University Heart and Diabetes Center North-Rhine and Westphalia, Department of Cardiology and Angiology – Bochum, Germany
  4. First Department of Medicine, University Medical Center Mannheim – Mannheim, Germany
  5. MediClin Heart Center – Lahr, Germany

open access

Ahead of print
Original articles
Submitted: 2022-07-25
Accepted: 2022-11-12
Published online: 2022-12-29

Abstract

Background: The prognostic impact of contrast-associated acute kidney injury (CA-AKI) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains underestimated. Methods: We examined 2707 consecutive procedures performed in a referral CTO center between 2015 and 2019. CA-AKI was defined as an increase in serum creatinine ≥ 0.3 mg/dL or ≥ 50% within 48 h post-PCI. Primary endpoints were in-hospital major adverse cardiac and cerebrovascular events (MACCE, composite of all-cause death, myocardial infarction, target vessel revascularization, stroke) and at one year of follow-up. Results: The overall incidence of CA-AKI was 11.5%. Technical success was comparable (87.2% vs. 90.5%, p = 0.056) whereas procedural success was lower in the CA-AKI group (84.3% vs. 89.7%, p = 0.004). Overall in-hospital MACCE was 1.3%, and it was similar in patients with and without CA-AKI (1.6% vs. 1.3%, p = 0.655); however, the rate of pericardial tamponade requiring pericardiocentesis was significantly higher in patients with CA-AKI (2.2% vs. 0.5%, p = 0.001). In multivariate analysis, CA-AKI was not independently associated with higher risk for in-hospital MACCE (adjusted odds ratio [OR] 1.34, 95% confidence intervals [CI] 0.45–3.19, p = 0.563). At a median follow-up time of 14 months (interquartile range [IQR], 11 to 35 months), one-year MACCE was significantly higher in patients with vs. without CA-AKI (20.8% vs. 12.8%, p < 0.001), and CA-AKI increased the risk for one-year MACCE (adjusted hazard ratio [HR] 1.46, 95% CI 1.07–1.95, p = 0.017) following CTO PCI. Conclusions: CA-AKI in patients undergoing CTO PCI occurs in approximately one out of 10 patients. Our study highlights that patients developing CA-AKI are at increased risk for long-term MACCE.

Abstract

Background: The prognostic impact of contrast-associated acute kidney injury (CA-AKI) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains underestimated. Methods: We examined 2707 consecutive procedures performed in a referral CTO center between 2015 and 2019. CA-AKI was defined as an increase in serum creatinine ≥ 0.3 mg/dL or ≥ 50% within 48 h post-PCI. Primary endpoints were in-hospital major adverse cardiac and cerebrovascular events (MACCE, composite of all-cause death, myocardial infarction, target vessel revascularization, stroke) and at one year of follow-up. Results: The overall incidence of CA-AKI was 11.5%. Technical success was comparable (87.2% vs. 90.5%, p = 0.056) whereas procedural success was lower in the CA-AKI group (84.3% vs. 89.7%, p = 0.004). Overall in-hospital MACCE was 1.3%, and it was similar in patients with and without CA-AKI (1.6% vs. 1.3%, p = 0.655); however, the rate of pericardial tamponade requiring pericardiocentesis was significantly higher in patients with CA-AKI (2.2% vs. 0.5%, p = 0.001). In multivariate analysis, CA-AKI was not independently associated with higher risk for in-hospital MACCE (adjusted odds ratio [OR] 1.34, 95% confidence intervals [CI] 0.45–3.19, p = 0.563). At a median follow-up time of 14 months (interquartile range [IQR], 11 to 35 months), one-year MACCE was significantly higher in patients with vs. without CA-AKI (20.8% vs. 12.8%, p < 0.001), and CA-AKI increased the risk for one-year MACCE (adjusted hazard ratio [HR] 1.46, 95% CI 1.07–1.95, p = 0.017) following CTO PCI. Conclusions: CA-AKI in patients undergoing CTO PCI occurs in approximately one out of 10 patients. Our study highlights that patients developing CA-AKI are at increased risk for long-term MACCE.

Get Citation

Keywords

percutaneous coronary intervention, contrast-associated acute kidney injury, outcomes

About this article
Title

Procedural outcomes of chronic total occlusion percutaneous coronary interventions in patients with acute kidney injury

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2022-12-29

Page views

178

Article views/downloads

85

DOI

10.5603/CJ.a2022.0121

Pubmed

36588312

Keywords

percutaneous coronary intervention
contrast-associated acute kidney injury
outcomes

Authors

Peter Tajti
Mohamed Ayoub
Abdelkrim Ahres
Faridun Rahimi
Michael Behnes
Heinz-Joachim Buettner
Franz-Josef Neumann
Dirk Westermann
Kambis Mashayekhi

References (28)
  1. Brilakis ES, Banerjee S, Karmpaliotis D, et al. Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv. 2015; 8(2): 245–253.
  2. Lemos PA, Arampatzis CA, Hoye A, et al. Impact of baseline renal function on mortality after percutaneous coronary intervention with sirolimus-eluting stents or bare metal stents. Am J Cardiol. 2005; 95(2): 167–172.
  3. Saltzman AJ, Stone GW, Claessen BE, et al. Long-term impact of chronic kidney disease in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial. JACC Cardiovasc Interv. 2011; 4(9): 1011–1019.
  4. Best PJM, Lennon R, Ting HH, et al. The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol. 2002; 39(7): 1113–1119.
  5. Latif F, Kleiman NS, Cohen DJ, et al. In-hospital and 1-year outcomes among percutaneous coronary intervention patients with chronic kidney disease in the era of drug-eluting stents: a report from the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry. JACC Cardiovasc Interv. 2009; 2(1): 37–45.
  6. Baber U, Giustino G, Sartori S, et al. Effect of chronic kidney disease in women undergoing percutaneous coronary intervention with drug-eluting stents: a patient-level pooled analysis of randomized controlled trials. JACC Cardiovasc Interv. 2016; 9(1): 28–38.
  7. Gupta T, Paul N, Kolte D, et al. Association of chronic renal insufficiency with in-hospital outcomes after percutaneous coronary intervention. J Am Heart Assoc. 2015; 4(6): e002069.
  8. Stähli BE, Gebhard C, Gick M, et al. Outcomes after percutaneous coronary intervention for chronic total occlusion according to baseline renal function. Clin Res Cardiol. 2018; 107(3): 259–267.
  9. Tajti P, Karatasakis A, Danek BA, et al. In-Hospital outcomes of chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease. J Invasive Cardiol. 2018; 30(11): E113–E121.
  10. Almendarez M, Gurm HS, Mariani J, et al. Procedural strategies to reduce the Incidence of contrast-induced acute kidney injury during percutaneous coronary intervention. JACC Cardiovasc Interv. 2019; 12(19): 1877–1888.
  11. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated acute kidney injury. N Engl J Med. 2019; 380(22): 2146–2155.
  12. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006(100): S11–S15.
  13. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120(4): c179–c184.
  14. Werner GS, Lorenz S, Yaginuma K, et al. A prospective study on the incidence of contrast-associated acute kidney injury after recanalization of chronic total coronary occlusions with contemporary interventional techniques. Int J Cardiol. 2021; 337: 38–43.
  15. 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.
  16. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018; 72(18): 2231–2264.
  17. Galassi AR, Werner GS, Boukhris M, et al. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EuroIntervention. 2019; 15(2): 198–208.
  18. Morino Y, Abe M, Morimoto T, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011; 4(2): 213–221.
  19. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9): 604–612.
  20. Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014; 63(5): 713–735.
  21. Tsai TT, Patel UD, Chang TI, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv. 2014; 7(1): 1–9.
  22. James MT, Ghali WA, Tonelli M, et al. Acute kidney injury following coronary angiography is associated with a long-term decline in kidney function. Kidney Int. 2010; 78(8): 803–809.
  23. McCullough PA, Choi JP, Feghali GA, et al. Contrast-Induced acute kidney injury. J Am Coll Cardiol. 2016; 68(13): 1465–1473.
  24. Brar SS, Aharonian V, Mansukhani P, et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet. 2014; 383(9931): 1814–1823.
  25. Qian G, Fu Z, Guo J, et al. Prevention of contrast-induced nephropathy by central venous pressure-guided fluid administration in chronic kidney disease and congestive heart failure patients. JACC Cardiovasc Interv. 2016; 9(1): 89–96.
  26. Ali ZA, Karimi Galougahi K, Nazif T, et al. Imaging- and physiology-guided percutaneous coronary intervention without contrast administration in advanced renal failure: a feasibility, safety, and outcome study. Eur Heart J. 2016; 37(40): 3090–3095.
  27. Azzalini L, Laricchia A, Regazzoli D, et al. Ultra-Low contrast percutaneous coronary intervention to minimize the risk for contrast-induced acute kidney injury in patients with severe chronic kidney disease. J Invasive Cardiol. 2019; 31(6): 176–182.
  28. Tajti P, Xenogiannis I, Hall A, et al. Use of the DyeVert system in chronic total occlusion percutaneous coronary intervention. J Invasive Cardiol. 2019; 31(9): 253–259.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl