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Title: | Recanalization of Chronic Total Occlusions in Patients With vs Without Chronic Kidney Disease: The Impact of Contrast-Induced Acute Kidney Injury | Authors: | Azzalini, Lorenzo Ojeda, Soledad Demir, Ozan M. DENS, Jo Tanabe, Masaki La Manna, Alessio Benincasa, Susanna Bellini, Barbara Poletti, Enrico Maccagni, Davide Hidalgo, Francisco Chavarria, Jorge MAEREMANS, Joren Gravina, Giacomo Micciche, Eligio D'Agosta, Guido Venuti, Giuseppe Tamburino, Corrado Pan, Manuel Carlino, Mauro Colombo, Antonio |
Issue Date: | 2018 | Publisher: | ELSEVIER SCIENCE INC | Source: | CANADIAN JOURNAL OF CARDIOLOGY, 34(10), p. 1275-1282 | 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. | Notes: | [Azzalini, Lorenzo; Demir, Ozan M.; Benincasa, Susanna; Bellini, Barbara; Poletti, Enrico; Maccagni, Davide; Carlino, Mauro; Colombo, Antonio] Ist Sci San Raffaele, Cardiothorac Vasc Dept, Intervent Cardiol Unit, Milan, Italy. [Ojeda, Soledad; Hidalgo, Francisco; Chavarria, Jorge; Pan, Manuel] Univ Cordoba, Reina Sofia Hosp, Maimonides Inst Res Biomed Cordoba IMIBIC, Div Intervent Cardiol, Cordoba, Spain. [Dens, Joseph; Maeremans, Joren] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium. [Tanabe, Masaki] Kyoto Okamoto Mem Hosp, Dept Cardiol, Kyoto, Japan. [La Manna, Alessio; Gravina, Giacomo; Micciche, Eligio; D'Agosta, Guido; Venuti, Giuseppe; Tamburino, Corrado] Univ Catania, Ferrarotto Hosp, Div Cardiol, Catania, Italy. [Maeremans, Joren] Univ Hasselt, Fac Med & Life Sci, Hasselt, Belgium. | Document URI: | http://hdl.handle.net/1942/28751 | ISSN: | 0828-282X | e-ISSN: | 1916-7075 | DOI: | 10.1016/j.cjca.2018.07.012 | ISI #: | 000445893600011 | Rights: | 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2019 |
Appears in Collections: | Research publications |
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