Wei-Chieh Lee1,2, Po-Jui Wu1, Chih-Yuan Fang1, Huang-Chung Chen1, Chiung-Jen Wu1, Hsiu-Yu Fang1. 1. Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan. 2. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 83301, Taiwan.
Abstract
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.
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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