Feasibility, Safety, and Long-Term Outcomes of Zero-Contrast Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease

Abstract

injury (AKI) development. Many studies have demonstrated that worsening renal function due to contrast use is strongly associated with cardiovascular events. 7-9 It is also known that an under-expanding stent is associated with target vessel failure after PCI. 10,11 Thus, a high-quality imaging-guided PCI procedure with less contrast volume should improve the clinical outcomes of patients with CKD and ischemic heart disease. There is some evidence that mini-contrast PCI prevents renal events; 12-16 however, little data are available on the feasibility and safety of zerocontrast PCI for patients with CKD, 17,18 and the long-term I t is well known that patients with chronic kidney disease (CKD) have a high cardiovascular event rate. 1-4 The recent ISCHEMIA-CKD trial demonstrated that an initial invasive strategy did not improve the clinical outcomes in patients with moderate or severe ischemic heart disease and advanced CKD compared with an initial conservative strategy. 5 One explanation may be that most acute coronary syndrome cases occur as a consequence of plaque rupture in arteries without high-grade stenosis. Thus, prevention of acute coronary syndrome by prophylactic revascularization with percutaneous coronary intervention (PCI) is often difficult. 6 The more important cause may be contrast use during the PCI procedure. CKD is the strongest predictor of contrast-associated acute kidney Editorial p ????

Safety of ultra‐low contrast coronary angiography in patients with acute kidney injury

“…Moreover, even low-contrast percutaneous coronary intervention was previously shown to be feasible and safe. 11,16 Previous studies showed the feasibility of coronary angiography in patients with CKD 10,11,17 and mean eGFR as low as 16 mL/min/ 1.73 m 2 . 10,11,17 Median contrast administered was 8.8-13.5 mL 10,11 even among patients with prior coronary artery bypass grafts.…”

“…Accordingly, none of the patients in the current study showed worsening renal function. Moreover, even low‐contrast percutaneous coronary intervention was previously shown to be feasible and safe 11,16 …”

“…Moreover, even low‐contrast percutaneous coronary intervention was previously shown to be feasible and safe. 11 , 16 …”

Intravascular Imaging for Percutaneous Coronary Intervention Guidance and Optimization: The Evidence for Improved Patient Outcomes

“…IVUS-guided stenting can be performed without any contrast, even in complex interventions. [82][83][84][85][86] This minimizes contrast-induced nephropathy and the need for renal replacement therapy. A similar approach is useful for patients with severe contrast allergies.…”

When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention

“…Since then, larger studies have been conducted by Rahim et al and Shibata et al, which both consistently showed that “zero contrast” PCI may be safely performed even in complex lesions with high procedural success and minimal complications, with satisfactory acute and long-term renal and cardiovascular outcomes. 58 , 59 …”