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. 2024;31(1):84-94.
doi: 10.5603/CJ.a2022.0121. Epub 2023 Jan 2.

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

Peter Tajti  1   2 , Mohamed Ayoub  3 , Abdelkrim Ahres  4 , Faridun Rahimi  5 , Michael Behnes  6 , Heinz-Joachim Buettner  5 , Franz-Josef Neumann  5 , Dirk Westermann  5 , Kambis Mashayekhi  5   7
Affiliations

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

Peter Tajti et al. Cardiol J. 2024.

Abstract

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.

Keywords: contrast-associated acute kidney injury; outcomes; percutaneous coronary intervention.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
The incidence of contrast-associated acute kidney injury increased with lesion complexity classified by J-CTO score (p = 0.009); CTO — chronic total occlusion; J — Japanese.
Figure 2
Figure 2
Kaplan–Meier curves of 1-year major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing chronic total occlusion percutaneous coronary interventions (PCI) with and without contrast-associated acute kidney injury (CA-AKI); MI — myocardial infarction; TLR — target lesion revascularization; TVR — target vessel revascularization
Figure 3
Figure 3
Kaplan-Meier curves of one-year major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing successful (A) versus failed (B) percutaneous coronary interventions (PCI) for chronic total occlusion (CTO) with and without contrast-associated acute kidney injury (CA-AKI).
See this image and copyright information in PMC

References

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