Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry

Nakatani, Tatsuya; Kohsaka, Shun; Yamane, Masahisa; Muramatsu, Toshiya; Okamura, Atsunori; Kashima, Yoshifumi; Matsuno, Seiki; Sakurada, Masami; Kijima, Mikihiko; Takao, Masaki; Habara, Maoto

doi:10.1161/jaha.117.006431

Cited by 6 publications

(8 citation statements)

References 28 publications

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“…There are several possible explanations for these findings, including younger age patients, less STEMI presentation, less cardiogenic shock and mostly of the PCI procedure were planned. Our study supported the previous studies that contemporary PCI is feasible and safe in appropriated selected patients with higher technical success and acceptable complication rates, even though they require more complex PCI procedure 27 . However, it needs to be emphasize that the 1‐year all‐cause mortality in these patients was still high after adjustment for other risk factors which mostly was driven by CV death or sudden death (56.5%) and additional unplanned revascularization.…”

Section: Discussionsupporting

confidence: 87%

“…Impaired renal function was the study factor of interest and was classified into six CKD groups: stage I (GFR ≥ 90), stage II (GFR 60−89), stage III (GFR 30−59), stage IV, 15–29 stage V (GFR < 15 ml/min/1.73 m 2 ) without dialysis, and stage V with dialysis. The estimated GFR (ml/min/1.73 m 2 ) was calculated based on the CKD epidemiology collaboration (CKD‐EPI) equations 22 …”

Section: Methodsmentioning

confidence: 99%

“…The registry protocol was published previously 21 [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] stage V (GFR < 15 ml/ min/1.73 m 2 ) without dialysis, and stage V with dialysis. The estimated GFR (ml/min/1.73 m 2 ) was calculated based on the CKD epidemiology collaboration (CKD-EPI) equations.…”

Section: Methodsmentioning

confidence: 99%

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Dose‐dependent effect of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention

Limpijankit

Chandavimol

Srimahachota

et al. 2022

Clinical Cardiology

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Objective To determine the risk prediction of various degrees of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention (PCI). Background Patients with chronic kidney disease (CKD) are at high risk of all‐cause mortality after PCI. However, there are less data of various degrees of impaired renal function to predict those risks. Methods This was a subgroup analysis of nationwide PCI registry of 22 045 patients. Patients were classified into six CKD stages according to preprocedure estimated glomerular filtration rate (eGFR) (ml/min/1.73 m2): I (≥90), II (60−89), III (30−59), IV (15−29), or V (<15) without or with dialysis. Baseline clinical and angiographic characteristics were compared among patients in each stage. One‐year all‐cause mortality was reported with risk prediction based on CKD stages and other risk factors. Results Patients with CKD stage I−V without and with on dialysis were found in 26.9%, 40.8%, 23.2%, 3.9%, 1.5%, and 3.7%, respectively. PCI procedural success and complication rates ranged from 94.0% to 96.2% and 2.8% to 6.1%, respectively. One‐year overall survival among CKD stages I−V was 96.3%, 93.1%, 84.4%, 65.2%, 68.0%, and 69.4%, respectively (p < .001 by log‐rank test). After adjusting covariables, the hazard ratios of all‐cause mortality for CKD stages II−V as compared to stage I by multivariate Cox regression analysis were 1.5, 2.6, 5.3, 5.9, and 7.0, respectively, (p < .001). Conclusion Among patients undergoing PCI, lower preprocedure eGFR is associated in a dose‐dependent effect with decreased 1‐year survival. This finding may be useful for risk classification and to guide decision‐making.

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Section: Discussionsupporting

confidence: 87%

Section: Methodsmentioning

confidence: 99%

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Dose‐dependent effect of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention

Limpijankit

Chandavimol

Srimahachota

et al. 2022

Clinical Cardiology

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“…Several important prognostic factors, such as reduced left ventricular ejection fraction [11], anemia [12], and hemodialysis [13], have been identified, albeit the prognostic benefit of successful CTO-PCI does not differ according to the presence or absence of these prognostic factors. These factors are helpful in identifying high-risk patients who require close clinical follow-up and/or aggressive risk factor modification.…”

Section: Introductionmentioning

confidence: 99%

Scoring System for Identification of “Survival Advantage” after Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion

Nakatani¹,

Kohsaka

Yamane

et al. 2020

JCM

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Background: Percutaneous coronary intervention (PCI) is widely used in patients with chronic total occlusion (CTO), but its benefit in improving long-term outcomes is controversial. We aimed to develop a prediction score for grading “survival advantage” conferred by successful results of CTO-PCI and a scoring system for prediction of the influence of CTO-PCI results on major adverse cardiac and cerebrovascular events (MACCEs). Methods: Follow-up data of 2625 patients who underwent CTO-PCI at 65 Japanese centers were analyzed. An integer scoring system was developed by including statistical effect modifiers on the association between successful CTO-PCI and one-year mortality. Results: Follow-up at 12 months was completed in 2034 patients. During follow-up, 76 deaths (3.7%) occurred. Patients with successful CTO-PCI had a better one-year survival than patients with failed CTO-PCI (log rank P = 0.016). Effect modifiers for the association between successful procedure and one-year mortality included diabetes (P interaction = 0.043), multivessel disease (P interaction = 0.175), Canadian Cardiovascular Society class ≥2 (P interaction = 0.088), and prior myocardial infarction (MI) (P interaction = 0.117). Each component was assigned a single point and summed to develop the scoring system. The patients were then categorized to specify the prediction of survival advantage by successful PCI: ≤2 (normal) and ≥3 (distinct). The differences in one-year mortality between patients with successful and failed treatment were −0.7% and 11.3% for normal and distinct score categories, respectively. In the scoring system for MACCE, score components were prior MI (P interaction = 0.19), left anterior descending artery (LAD)-CTO (P interaction = 0.079), and reattempt of CTO-PCI (P interaction = 0.18). The differences in one-year MACCEs between successful and failed patients for each score category (0, 1, and ≥2) were −1.7%, 7.5%, and 15.1%, respectively. Conclusions: The novel scoring system assessing the advantage of successful PCI can be easily applied in patients with CTO. It is a valid instrument for clinical decision-making while assessing the survival advantage of CTO-PCI and the influence of procedural results on MACCEs.

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“…Hemodialysis is generally thought to be one of the major risk factors for cardiovascular events after percutaneous coronary intervention (PCI) [5][6][7]. Previous studies have revealed poor clinical outcomes among hemodialysis patients after PCI in comparison with non-hemodialysis patients in long-term clinical follow-up [8][9][10][11]. Diffuse and severe calcifications are typical lesion characteristics after PCI in hemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Long-term clinical outcomes after percutaneous coronary intervention to treat long lesions in hemodialysis patients in the era of second-generation drug-eluting stents

Soontorndhada

Tanaka

Yamaguchi

et al. 2020

Journal of Cardiology

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Background: There is little knowledge about clinical outcomes after the percutaneous coronary intervention (PCI) in hemodialysis patients with long lesions. The objective of the present study was to examine the long-term prognosis after PCI in hemodialysis patients in the second-generation drugeluting stents (DES) era. Methods: We retrospectively enrolled 270 consecutive hemodialysis patients who underwent PCI using second-generation DES from January 2010 to July 2015. We defined long lesions as the total stent length >30 mm. In total, 96 hemodialysis patients (35.6%) underwent PCI for long lesions. The median follow-up period was 2.7 years. The endpoints of this study were cardiac death, target lesion revascularization (TLR), and major adverse cardiovascular events (MACE), including cardiac death, non-fatal myocardial infarction, non-fatal stroke, stent thrombosis, and TLR. Results: The patients' baseline characteristics were similar between the long lesion and the non-long lesion groups, except for prior PCIs (long-lesion vs. non-long lesion = 30.2% vs. 46.0%; p = 0.01). Kaplan-Meier analyses revealed that the incidence of cardiac death, TLR, and MACE were comparable between the two groups (long lesion vs. non-long lesion; 5.2% vs. 5.7%, log-rank p = 0.84, 26.0% vs. 23.0%, log-rank p = 0.29, and 43.8% vs. 40.2%; log-rank p = 0.49, respectively). Conclusions: Clinical outcomes of PCI for long lesions in hemodialysis patients were similar to that of non-long lesions. Long-stenting in hemodialysis patients, who were considered high-risk subset of adverse cardiovascular events, might be acceptable in the second-generation DES era.

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Impact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry

Cited by 6 publications

References 28 publications

Dose‐dependent effect of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention

Dose‐dependent effect of impaired renal function on all‐cause mortality in patients following percutaneous coronary intervention

Scoring System for Identification of “Survival Advantage” after Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion

Long-term clinical outcomes after percutaneous coronary intervention to treat long lesions in hemodialysis patients in the era of second-generation drug-eluting stents

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