Procedural outcomes of chronic total occlusion percutaneous coronary interventions in patients with acute kidney injury
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.
Keywords: percutaneous coronary interventioncontrast-associated acute kidney injuryoutcomes
References
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Mehran R, Dangas GD, Weisbord SD. Contrast-associated acute kidney injury. N Engl J Med. 2019; 380(22): 2146–2155.
- Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006(100): S11–S15.
- Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120(4): c179–c184.
- 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.
- 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.
- Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018; 72(18): 2231–2264.
- 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.
- 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.
- Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9): 604–612.
- 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.
- 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.
- 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.
- McCullough PA, Choi JP, Feghali GA, et al. Contrast-Induced acute kidney injury. J Am Coll Cardiol. 2016; 68(13): 1465–1473.
- 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.
- 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.
- 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.
- 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.
- 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.
