Impact of Chronic Kidney Disease on Chronic Total Occlusion Revascularization Outcomes: A Meta-Analysis

Objectives: To examine the impact of revascularization and associated clinical outcomes of chronic kidney disease (CKD) chronic total occlusion (CTO) and non-CKD CTO groups. Background: The influence of CKD on clinical outcomes after percutaneous coronary intervention (PCI) for CTO lesions is unknown, and there is no systemic review of this topic to date. Methods: We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials Databases for articles published between 1 January 2010 and 31 March 2020. CKD was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease formula. Data included demographics, lesion distributions, incidence of contrast-induced nephropathy (CIN), acute kidney injury (AKI), procedural success rate, mortality, and target lesion revascularization (TLR)/target vessel revascularization (TVR). Results: Six studies were ultimately included in this systematic review. A high prevalence (25.5%; range, 19.6–37.9%) of CKD was noted in the CTO population. In the non-CKD group, outcomes were better: less incidence of CIN or AKI (odds ratio (OR), 2.860; 95% confidence interval (CI), 1.775–4.608), higher procedural success rate (OR, 1.382; 95% CI, 1.036–1.843), and lower long-term mortality (OR, 4.502; 95% CI, 3.561–5.693). The incidence of TLR/TVR (OR, 1.118; 95% CI, 0.888–1.407) did not differ between groups. Conclusions: In the CKD CTO PCI population, a lower procedural success rate, a higher incidence of CIN or AKI, and higher in-hospital and long-term mortality rate were noted due to more complex lesions and more comorbidities. However, the incidence of TLR/TVR did not differ between groups.

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A comparison of procedural success rate and long-term clinical outcomes between in-stent restenosis chronic total occlusion and de novo chronic total occlusion using multicenter registry data

Clinical Research in Cardiology ◽

10.1007/s00392-019-01550-7 ◽

2019 ◽

Vol 109 (5) ◽

pp. 628-637 ◽

Cited By ~ 1

Author(s):

Seung Hun Lee ◽

Jae Young Cho ◽

Je Sang Kim ◽

Hyun Jong Lee ◽

Jeong Hoon Yang ◽

...

Keyword(s):

Success Rate ◽

Clinical Outcomes ◽

Chronic Total Occlusion ◽

De Novo ◽

Drug Eluting Stent ◽

Total Occlusion ◽

Stent Restenosis ◽

Procedural Success ◽

In Stent Restenosis

Abstract Background There have been little data about outcomes of percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) chronic total occlusion (CTO) in the drug eluting stent (DES) era. This study aimed to compare the procedural success rate and long-term clinical outcomes of ISR CTO and de novo CTO. Methods and results Patients who underwent PCI for ISR CTO (n = 164) versus de novo CTO (n = 1208) were enrolled from three centers in Korea between January 2008 and December 2014. Among a total of ISR CTO, a proportion of DES ISR CTO was 79.3% (n = 130). The primary outcome was major adverse cardiac events (MACEs); a composite of all-cause death, non-fatal myocardial infarction (MI), or target lesion revascularization (TLR). Following propensity score-matching (1:3), the ISR CTO group (n = 156) had a higher success rate (84.6% vs. 76.0%, p = 0.035), mainly driven by high success rate of PCI for DES ISR CTO (88.6%), but showed a higher incidence of MACEs [hazard ratio (HR): 2.06; 95% confidence interval (CI) 1.37–3.09; p < 0.001], mainly driven by higher prevalence of MI [HR: 9.71; 95% CI 2.06–45.81; p = 0.004] and TLR [HR: 3.04; 95% CI 1.59–5.81; p = 0.001], during 5 years of follow-up after successful revascularization, as compared to the de novo CTO group (n = 408). Conclusion The procedural success rate was higher in the ISR CTO than the de novo CTO, especially in DES ISR CTO. However, irrespective of successful revascularization, the long-term clinical outcomes for the ISR CTO were significantly worse than those for the de novo CTO, in terms of MI and TLR. Graphic abstract

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P6449Impact of chronic kidney disease on 5-year clinical outcomes in patients with chronic total occlusion lesion

European Heart Journal ◽

10.1093/eurheartj/ehx493.p6449 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

S.W. Rha ◽

A. Mashaly ◽

S.-H. Park ◽

J.Y. Park ◽

A.-Y. Her ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Clinical Outcomes ◽

Chronic Total Occlusion ◽

Total Occlusion

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IN HOSPITAL AND LONG TERM OUTCOMES IN PATIENT WITH CHRONIC KIDNEY DISEASE UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FOR CORONARY CHRONIC TOTAL OCCLUSION: A META-ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31685-7 ◽

2019 ◽

Vol 73 (9) ◽

pp. 1078

Author(s):

Udit Joshi ◽

Harsh Rawal ◽

Hiren Patel ◽

Sagar Ranka ◽

Hitesh Chawla ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Percutaneous Coronary Intervention ◽

Kidney Disease ◽

Chronic Total Occlusion ◽

Meta Analysis ◽

Coronary Intervention ◽

Long Term Outcomes ◽

Total Occlusion ◽

Percutaneous Coronary

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Evaluation of the Effect of Concurrent Chronic Total Occlusion and Successful Staged Revascularization on Long-Term Mortality in Patients with ST-Elevation Myocardial Infarction

The Scientific World JOURNAL ◽

10.1155/2014/756080 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Guoxiang Shi ◽

Pengcheng He ◽

Yuanhui Liu ◽

Yaowang Lin ◽

Xing Yang ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Outcomes ◽

Chronic Total Occlusion ◽

Early Mortality ◽

Primary Pci ◽

Total Occlusion ◽

The Impact ◽

Long Term Mortality

Aims. To investigate the impact of chronic total occlusion (CTO) in non-infarct-related artery (IRA) on the long-term prognosis and evaluate the clinical significance of staged revascularization in patients with ST-segment elevation myocardial infarction (STEMI).Methods. 1266 STEMI patients with primary percutaneous coronary intervention (PCI) were categorized as single-vessel disease (SVD), multivessel disease (MVD) without and with CTO. We study the clinical outcomes of patients after primary PCI in the following 3 years. Additionally, patients with CTO received staged revascularization, and major adverse cardiac events (MACE) during 3-year follow-up were recorded.Results. Presence of CTO was a predictor of both early mortality [hazard ratio (HR) 3.4, 95% confidence interval (CI) 2.4–4.5,P<0.01] and late mortality (HR 1.9, 95% CI 1.4–3.6,P<0.01), whereas MVD without CTO was only a predictor of early mortality (HR 1.7, 95% CI 1.3–2.3,P<0.05). In CTO group, 100 patients had successful CTO recanalization, and 48 patients failed. During 3-year follow-up, patients with failed procedure had higher cardiac mortality (22.9% versus 9.0%,P=0.020) and lower MACE-free survival (50.0% versus 72.0%,P=0.009) compared to patients with successful procedure.Conclusion. The presence of CTO and not MVD alone is associated with long-term mortality. Successful revascularization of CTO in the non-IRA is associated with improved clinical outcomes in patients with STEMI undergoing primary PCI.

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