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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.
Tanabe, Masaki
La Manna, Alessio
Benincasa, Susanna
Bellini, Barbara
Poletti, Enrico
Maccagni, Davide
Hidalgo, Francisco
Chavarria, Jorge
Gravina, Giacomo
Micciche, Eligio
D'Agosta, Guido
Venuti, Giuseppe
Tamburino, Corrado
Pan, Manuel
Carlino, Mauro
Colombo, Antonio
Issue Date: 2018
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.
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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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