Ziad A Ali1,2, Keyvan Karimi Galougahi3, Tamim Nazif3,2, Akiko Maehara3,2, Mark A Hardy4, David J Cohen5, Lloyd E Ratner4, Michael B Collins3,2, Jeffrey W Moses3,2, Ajay J Kirtane3,2, Gregg W Stone3,2, Dimitri Karmpaliotis3,2, Martin B Leon3,2. 1. Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA zaa2112@columbia.edu. 2. Cardiovascular Research Foundation, New York, NY, USA. 3. Division of Cardiology, Center for Interventional Vascular Therapy, New York Presbyterian Hospital and Columbia University, New York, NY, USA. 4. Department of Surgery, New York Presbyterian Hospital and Columbia University, New York, NY, USA. 5. Division of Nephrology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.
Abstract
AIMS: The feasibility, safety, and clinical utility of percutaneous coronary intervention (PCI) without radio-contrast medium in patients with advanced chronic kidney disease (CKD) are unknown. In this series, we investigated a specific strategy for 'zero contrast' PCI with the aims of preserving renal function and preventing the need for renal replacement therapy (RRT) in patients with advanced CKD. METHODS AND RESULTS: A total of 31 patients with advanced CKD [creatinine = 4.2 mg/dL, inter-quartile range (IQR) 3.1-4.8, estimated glomerular filtration rate = 16 ± 8 mL/min/1.73 m2] who had clinical indication for PCI based on a prior minimal contrast coronary angiogram were included. Zero contrast PCI was performed at least 1 week after diagnostic angiography using real-time intravascular ultrasound (IVUS) guidance, with pre- and post-PCI measurements of fractional flow reserve and coronary flow reserve to confirm physiological improvement. This approach resulted in successful PCI, no major adverse cardiovascular events and preservation of renal function without the need for RRT within a follow-up time of 79 days (IQR 33-207) in all patients. CONCLUSION: In patients with advanced CKD who require revascularization, PCI may safely be performed without contrast using IVUS and physiological guidance with high procedural success and without complications. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The feasibility, safety, and clinical utility of percutaneous coronary intervention (PCI) without radio-contrast medium in patients with advanced chronic kidney disease (CKD) are unknown. In this series, we investigated a specific strategy for 'zero contrast' PCI with the aims of preserving renal function and preventing the need for renal replacement therapy (RRT) in patients with advanced CKD. METHODS AND RESULTS: A total of 31 patients with advanced CKD [creatinine = 4.2 mg/dL, inter-quartile range (IQR) 3.1-4.8, estimated glomerular filtration rate = 16 ± 8 mL/min/1.73 m2] who had clinical indication for PCI based on a prior minimal contrast coronary angiogram were included. Zero contrast PCI was performed at least 1 week after diagnostic angiography using real-time intravascular ultrasound (IVUS) guidance, with pre- and post-PCI measurements of fractional flow reserve and coronary flow reserve to confirm physiological improvement. This approach resulted in successful PCI, no major adverse cardiovascular events and preservation of renal function without the need for RRT within a follow-up time of 79 days (IQR 33-207) in all patients. CONCLUSION: In patients with advanced CKD who require revascularization, PCI may safely be performed without contrast using IVUS and physiological guidance with high procedural success and without complications. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Keyvan Karimi Galougahi; Adrian Zalewski; Martin B Leon; Dimitri Karmpaliotis; Ziad A Ali Journal: Eur Heart J Date: 2015-12-18 Impact factor: 29.983
Authors: George Dangas; Ioannis Iakovou; Eugenia Nikolsky; Eve D Aymong; Gary S Mintz; Nicholas N Kipshidze; Alexandra J Lansky; Issam Moussa; Gregg W Stone; Jeffrey W Moses; Martin B Leon; Roxana Mehran Journal: Am J Cardiol Date: 2005-01-01 Impact factor: 2.778
Authors: Somjot S Brar; Vicken Aharonian; Prakash Mansukhani; Naing Moore; Albert Y-J Shen; Michael Jorgensen; Aman Dua; Lindsay Short; Kevin Kane Journal: Lancet Date: 2014-05-24 Impact factor: 79.321
Authors: S A Chamuleau; M Meuwissen; B L van Eck-Smit; K T Koch; A de Jong; R J de Winter; C E Schotborgh; M Bax; H J Verberne; J G Tijssen; J J Piek Journal: J Am Coll Cardiol Date: 2001-04 Impact factor: 24.094
Authors: Keshav R Nayak; Hirsch S Mehta; Matthew J Price; Robert J Russo; Curtiss T Stinis; Jeffrey W Moses; Roxana Mehran; Martin B Leon; David E Kandzari; Paul S Teirstein Journal: Catheter Cardiovasc Interv Date: 2010-06-01 Impact factor: 2.692
Authors: Donal N Reddan; Lynda Anne Szczech; Robert H Tuttle; Linda K Shaw; Robert H Jones; Steve J Schwab; Mark Stafford Smith; Robert M Califf; Daniel B Mark; William F Owen Journal: J Am Soc Nephrol Date: 2003-09 Impact factor: 10.121
Authors: Łukasz Pyka; Michał Hawranek; Krzysztof Wilczek; Jacek Piegza; Janusz Szkodzinski; Andrzej Lekston; Mariusz Gąsior Journal: Cardiol J Date: 2019 Impact factor: 2.737
Authors: Sripal Bangalore; David J Maron; Jerome L Fleg; Sean M O'Brien; Charles A Herzog; Gregg W Stone; Daniel B Mark; John A Spertus; Karen P Alexander; Mandeep S Sidhu; Glenn M Chertow; William E Boden; Judith S Hochman Journal: Am Heart J Date: 2018-08-01 Impact factor: 4.749
Authors: Peter Tajti; Iosif Xenogiannis; Dimitris Karmpaliotis; Khaldoon Alaswad; Farouc A Jaffer; M Nicholas Burke; Imre Ungi; Emmanouil S Brilakis Journal: Curr Cardiol Rep Date: 2018-10-22 Impact factor: 2.931
Authors: Sripal Bangalore; David J Maron; Sean M O'Brien; Jerome L Fleg; Evgeny I Kretov; Carlo Briguori; Upendra Kaul; Harmony R Reynolds; Tomasz Mazurek; Mandeep S Sidhu; Jeffrey S Berger; Roy O Mathew; Olga Bockeria; Samuel Broderick; Radoslaw Pracon; Charles A Herzog; Zhen Huang; Gregg W Stone; William E Boden; Jonathan D Newman; Ziad A Ali; Daniel B Mark; John A Spertus; Karen P Alexander; Bernard R Chaitman; Glenn M Chertow; Judith S Hochman Journal: N Engl J Med Date: 2020-03-30 Impact factor: 91.245