Rates of future hemodialysis risk and beneficial outcomes for patients with chronic kidney disease undergoing recanalization of chronic total occlusion. (1st November 2016)

• Record Type: Journal Article
• Authors: Shimura, Tetsuro; Yamamoto, Masanori; Tsuchikane, Etsuo; Teramoto, Tomohiko; Kimura, Masashi; Matsuo, Hitoshi; Kawase, Yoshiaki; Suzuki, Yoriyasu; Kano, Seiji; Habara, Maoto; Nasu, Kenya; Kinoshita, Yoshihisa; Terashima, Mitsuyasu; Matsubara, Tetsuo; Suzuki, Takahiko
• Is Part Of: International journal of cardiology. Volume 222(2016)
• Page Start: 707
• Page End: 713
• Publication Date: 2016-11-01
• Subjects: Coronary artery disease -- Chronic kidney disease -- Chronic total occlusion -- Percutaneous coronary intervention -- Hemodialysis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.08.019
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: This study aimed to assess the prognosis and deleterious effects of chronic kidney disease (CKD) on future renal function, in patients who had undergone chronic total occlusion-percutaneous coronary intervention (CTO-PCI). Methods: The treatment effects were studied in 739 patients who underwent CTO-PCI. The patients were divided into 3 groups according to estimated glomerular filtration rate (eGFR): non-CKD (eGFR ≥ 60 ml/min/1.73m 2, n = 562), CKD-1 (45 ≤ eGFR < 60 ml/min/1.73m 2, n = 90), and CKD-2 (eGFR < 45 ml/min/1.73m 2, n = 87). Future hemodialysis (HD) rates and the prevalence of acute kidney injury (AKI) except for 45 patients undergoing regular HD, and other clinical and prognostic outcomes were compared between the 3 groups. Results: Procedural success rates showed trends toward lower prevalence across the 3 groups (89.5%, 84.4%, and 81.6%, p = 0.060). The prevalence of AKI significantly differed between the 3 groups (4.6%, 8.9%, and 16.7%, p = 0.001), whereas no patients were introduced to regular HD at discharge. During a median follow-up period of 51.2 ± 28.9 months, newly required HD significantly differed between the 3 groups (0.7%, 0%, and 7.1%, p < 0.001). When compared with unsuccessful CTO-PCI, successful CTO-PCI was found to improve cardiovascular mortality in the non-CKD and CKD-1 (Log-rank test: p = 0.025, p = 0.024, respectively) and to improve both cardiovascular and all-cause mortality in the CKD-2 (Log-rank test: p = 0.027, p = 0.0022, respectively). Conclusions: Although CTO-PCI for patients with advanced CKD was associated with a high risk of future HD introduction, not directly owing to CTO-PCI and AKI, successful treatment of CTO might contribute to better survival benefit regardless of the presence or absence of CKD.