Percutaneous coronary intervention for chronic total occlusion improved prognosis in patients with renal insufficiency at high risk of contrast-induced nephropathy.

Yong Liu,Ning Tan,Yingling Zhou,Jiyan Chen,Shiqun Chen,Hualong Li,Chongyang Duan,Pingyan Chen,Yuanhui Liu,Wei Guo

doi:10.1038/srep21426

Abstract

We investigated whether attempted percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) would improve the prognosis in patients with renal insufficiency at high risk of contrast-induced nephropathy (CIN). We analyzed 2,330 consecutive patients with renal insufficiency with or without CTOs who underwent coronary angiography or PCI from prospectively collected data. The long-term death and risk of CIN were evaluated among three groups: patients without CTOs (group A, n = 1,829), patients with un-attempted PCI for CTOs (group B, n = 142), and patients who underwent attempted PCI for CTOs (group C, n = 359). Overall, group B and group C (successful rate, 89%) patients had similar renal function and were not significantly associated with an increased risk of CIN (adjusted odds ratio [OR] = 0.88, 95% confidence interval [CI]: 0.41–1.93, P = 0.758). During a 2.33-year period (median), multivariate analysis demonstrated that attempted PCI for CTOs was independently associated with lower mortality (adjusted hazard ratio for death: 0.38, 95% CI: 0.18–0.83; P = 0.015). Attempted PCI for CTOs improved the long-term prognosis in patients with high-risk renal insufficiency and did not increase the risk of CIN.

Highlights

We investigated whether attempted percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) will improve prognosis in patients with renal insufficiency at high risk of CIN
The independent risk factors of death included CIN25%/0.5 and left ventricular ejection fraction (LVEF) < 40% (Fig. 4). This was the first retrospective analysis, based on prospectively collected data,that evaluated the effect of attempted PCI for CTOs on the risk of CIN and the prognosis in high-risk patients with renal insufficiency
Our observational data showed that attempted PCI for CTOs had a high success rate (89%), and it still improved the long-term prognosis without increasing the risk of CIN in patients with renal insufficiency

Summary

Introduction

We investigated whether attempted PCI for CTOs will improve prognosis in patients with renal insufficiency at high risk of CIN. The incidence of renal replacement therapy, in-hospital mortality, and other adverse events were not higher in patients who underwent attempted PCI for CTOs than in the other groups (Table 3).

Results

Conclusion