Outcomes after percutaneous coronary intervention for chronic total occlusion according to baseline renal function

Clinical Research in Cardiology - Tập 107 - Trang 259-267 - 2017
Barbara E. Stähli1, Cathérine Gebhard2, Michael Gick2, Miroslaw Ferenc3, Kambis Mashayekhi2, Heinz Joachim Buettner3, Franz-Josef Neumann3, Aurel Toma3
1Department of Cardiology, Charité Berlin – University Medicine, Campus Benjamin Franklin, Berlin, Germany
2Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
3Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Bad Krozingen, Germany

Tóm tắt

Chronic kidney disease (CKD) adversely affects outcomes in patients with coronary artery disease. Data on the impact of renal impairment on prognosis of patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) are scarce. A total of 2002 patients undergoing CTO PCI were stratified according to baseline renal function (group 1: estimated glomerular filtration rate [eGFR] ≥ 90 ml/min/1.73 m2, group 2: 60 to 89 ml/min/1.73 m2, group 3: 30 to 59 ml/min/1.73 m2, and group 4: <30 ml/min/1.73 m2). The primary outcome measure was all-cause mortality at a median follow-up of 2.6 (interquartile range 1.1–3.1) years. All-cause mortality increased with decreasing renal function (group 1: 5.0%, group 2: 9.5%, group 3: 26.4%, and group 4: 38.7%, log rank p < 0.001). Continuous eGFR values were significantly related with all-cause mortality (adjusted HR 0.98, 95% CI 0.98–0.99, p < 0.001). Procedural failure was associated with all-cause mortality both in patients with an eGFR < 60 ml/min/1.73 m2 (42.6 vs. 23.7%, adjusted HR 1.59, 95% CI 1.08–2.32, p = 0.02) and in those with an eGFR ≥ 60 ml/min/1.73 m2 (14.6 vs. 6.5%, adjusted HR 1.73, 95% CI 1.15–2.60, p = 0.009, interaction p = 0.47). Although renal impairment is associated with all-cause mortality in patients undergoing CTO PCI, successful CTO recanalization is related to improved survival irrespective of renal function.

Tài liệu tham khảo

George S, Cockburn J, Clayton TC, Ludman P, Cotton J, Spratt J et al (2014) Long-term follow-up of elective chronic total coronary occlusion angioplasty: analysis from the U.K. Central Cardiac Audit Database. J Am Coll Cardiol 64:235–243

Suero JA, Marso SP, Jones PG, Laster SB, Huber KC, Giorgi LV et al (2001) Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol 38:409–414

Mehran R, Claessen BE, Godino C, Dangas GD, Obunai K, Kanwal S et al (2011) Long-term outcome of percutaneous coronary intervention for chronic total occlusions. J Am Coll Cardiol Cardiovasc Interv 4:952–961

Hoebers LP, Claessen BE, Elias J, Dangas GD, Mehran R, Henriques JP (2015) Meta-analysis on the impact of percutaneous coronary intervention of chronic total occlusions on left ventricular function and clinical outcome. Int J Cardiol 187:90 – 6

Tomasello SD, Boukhris M, Giubilato S, Marza F, Garbo R, Contegiacomo G et al (2015) Management strategies in patients affected by chronic total occlusions: results from the Italian Registry of Chronic Total Occlusions. Eur Heart J 36:3189–3198

Morino Y, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y et al (2010) In-hospital outcomes of contemporary percutaneous coronary intervention in patients with chronic total occlusion insights from the J-CTO Registry (Multicenter CTO Registry in Japan). J Am Coll Cardiol Cardiovasc Interv 3:143 –151

Toma A, Gebhard C, Gick M, Ademaj F, Stahli BE, Mashayekhi K et al (2017) Survival after percutaneous coronary intervention for chronic total occlusion in elderly patients. EuroIntervention 13(2):e228–e235

Campbell NG, Varagunam M, Sawhney V, Ahuja KR, Salahuddin N, De Palma R et al (2012) Mild chronic kidney disease is an independent predictor of long-term mortality after emergency angiography and primary percutaneous intervention in patients with ST-elevation myocardial infarction. Heart 98:42–47

Schiele F, Legalery P, Didier K, Meneveau N, Seronde MF, Caulfield F et al (2006) Impact of renal dysfunction on 1-year mortality after acute myocardial infarction. Am Heart J 151:661–667

Sadeghi HM, Stone GW, Grines CL, Mehran R, Dixon SR, Lansky AJ et al (2003) Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation 108:2769–2775

Cooper WA, O’Brien SM, Thourani VH, Guyton RA, Bridges CR, Szczech LA et al (2006) Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 113:1063–1070

Zhang QB, Chen LM, Li M, Cui YQ, Zhao CY, Cui LQ (2016) Influence of chronic kidney disease on the outcome of patients with chronic total occlusion. Am J Transl Res 8:196–208

Shimura T, Yamamoto M, Tsuchikane E, Teramoto T, Kimura M, Matsuo H et al. Rates of future hemodialysis risk and beneficial outcomes for patients with chronic kidney disease undergoing recanalization of chronic total occlusion. Int J Cardiol 2016;222:707 – 13

Toma A, Gick M, Minners J, Ferenc M, Valina C, Loffelhardt N et al (2016) Survival after percutaneous coronary intervention for chronic total occlusion. Clin Res Cardiol 105(11):921–929

Stahli BE, Gebhard C, Gick M, Herman C, Ferenc M, Mashayekhi K et al (2016) Impact of body mass index on long-term mortality in women and men undergoing percutaneous coronary intervention for chronic total occlusion. Int J Cardiol 224:305–309

Toma A, Stahli BE, Gick M, Colmsee H, Gebhard C, Mashayekhi K et al (2016) Long-term follow-up of patients with previous coronary artery bypass grafting undergoing percutaneous coronary intervention for chronic total occlusion. The Am J Cardiol 118(11):1641–1646

Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J et al (2014) 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–2619

Task Force M, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C et al (2013) 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34:2949–3003

Sianos G, Werner GS, Galassi AR, Papafaklis MI, Escaned J, Hildick-Smith D et al (2012) Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club. EuroIntervention 8:139–145

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI et al (2009) A new equation to estimate glomerular filtration rate. Ann Int Med 150:604–612

National Kidney F (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1-266

An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators. New Engl J Med. 1993;329:673–682

Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B et al (2013) Chronic kidney disease: global dimension and perspectives. The Lancet 382:260 – 72

Kaya E, Cuneo A, Hochadel M, Junger C, Stepper W, Bramlage P et al (2011) Impact of chronic kidney disease on the prognosis of patients undergoing percutaneous coronary interventions using drug-eluting stents. Clin Res Cardiol 100:1103–1109

Jones DA, Weerackody R, Rathod K, Behar J, Gallagher S, Knight CJ et al (2012) Successful recanalization of chronic total occlusions is associated with improved long-term survival. J Am Coll Cardiol Cardiovasc Interv 5:380–388

Thông tin
Thông tin xuất bản

Clinical Research in Cardiology

Tập 107

259-267

Thông tin tác giả