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

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Authors and Affiliations

  1. Department of Cardiology, Charité Berlin, University Medicine, Campus Benjamin Franklin, Berlin, Germany

    Barbara E. Stähli

  2. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Suedring 15, 79189, Bad Krozingen, Germany

    Cathérine Gebhard, Michael Gick, Miroslaw Ferenc, Kambis Mashayekhi, Heinz Joachim Buettner, Franz-Josef Neumann & Aurel Toma

Authors
  1. Barbara E. Stähli
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  2. Cathérine Gebhard
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  3. Michael Gick
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  4. Miroslaw Ferenc
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  5. Kambis Mashayekhi
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  6. Heinz Joachim Buettner
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  7. Franz-Josef Neumann
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  8. Aurel Toma
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Correspondence to Aurel Toma.

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Stähli, B.E., Gebhard, C., Gick, M. et al. Outcomes after percutaneous coronary intervention for chronic total occlusion according to baseline renal function. Clin Res Cardiol 107, 259–267 (2018). https://doi.org/10.1007/s00392-017-1179-x

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  • DOI: https://doi.org/10.1007/s00392-017-1179-x

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