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Procedural outcomes of chronic total occlusion percutaneous coronary interventions in patients with acute kidney injury

Background: The prognostic impact of contrast-associated acute kidney injury (CA-AKI) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains underestimated. Methods: We examined 2707 consecutive procedures performed in a referral CTO center between 20...

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Main Authors: Tajti, Péter (Author) , Ayoub, Mohamed (Author) , Ahres, Abdelkrim (Author) , Rahimi, Faridun (Author) , Behnes, Michael (Author) , Büttner, Heinz-Joachim (Author) , Neumann, Franz-Josef (Author) , Westermann, Dirk (Author) , Mashayekhi, Kambis (Author)
Format: Article (Journal)
Language:English
Published: 2024
In: Cardiology journal
Year: 2024, Volume: 31, Issue: 1, Pages: 84-94
ISSN:1898-018X
DOI:10.5603/CJ.a2022.0121
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.5603/CJ.a2022.0121
Verlag, kostenfrei, Volltext: https://journals.viamedica.pl/cardiology_journal/article/view/CJ.a2022.0121
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Author Notes:Peter Tajti, Mohamed Ayoub, Abdelkrim Ahres, Faridun Rahimi, Michael Behnes, Heinz-Joachim Buettner, Franz-Josef Neumann, Dirk Westermann, Kambis Mashayekhi
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Summary:Background: The prognostic impact of contrast-associated acute kidney injury (CA-AKI) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains underestimated. Methods: We examined 2707 consecutive procedures performed in a referral CTO center between 2015 and 2019. CA-AKI was defined as an increase in serum creatinine ≥ 0.3 mg/dL or ≥ 50% within 48 h post-PCI. Primary endpoints were in-hospital major adverse cardiac and cerebrovascular events (MACCE, composite of all-cause death, myocardial infarction, target vessel revascularization, stroke) and at one year of follow-up. Results: The overall incidence of CA-AKI was 11.5%. Technical success was comparable (87.2% vs. 90.5%, p = 0.056) whereas procedural success was lower in the CA-AKI group (84.3% vs. 89.7%, p = 0.004). Overall in-hospital MACCE was 1.3%, and it was similar in patients with and without CA-AKI (1.6% vs. 1.3%, p = 0.655); however, the rate of pericardial tamponade requiring pericardiocentesis was significantly higher in patients with CA-AKI (2.2% vs. 0.5%, p = 0.001). In multivariate analysis, CA-AKI was not independently associated with higher risk for in-hospital MACCE (adjusted odds ratio [OR] 1.34, 95% confidence intervals [CI] 0.45-3.19, p = 0.563). At a median follow-up time of 14 months (interquartile range [IQR], 11 to 35 months), one-year MACCE was significantly higher in patients with vs. without CA-AKI (20.8% vs. 12.8%, p < 0.001), and CA-AKI increased the risk for one-year MACCE (adjusted hazard ratio [HR] 1.46, 95% CI 1.07-1.95, p = 0.017) following CTO PCI. Conclusions: CA-AKI in patients undergoing CTO PCI occurs in approximately one out of 10 patients. Our study highlights that patients developing CA-AKI are at increased risk for long-term MACCE.
Item Description:Online veröffentlicht: 2022-12-29
Gesehen am 23.07.2024
Physical Description:Online Resource
ISSN:1898-018X
DOI:10.5603/CJ.a2022.0121

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