Although contemporary chronic total occlusion (CTO) percutaneous coronary intervention
(PCI) is performed with high success rates, 10% to 13% of patients presenting with
CTOs have chronic kidney disease (CKD), and the comparative safety, efficacy, and
health status benefit of CTO PCI in these patients, has not been well defined. We
examined the association of baseline renal function with periprocedural major adverse
cardiovascular and cerebral events and health status outcomes in 957 consecutive patients
(mean age 65.3 ± 10.3 years, 19.4% women, 90.3% white, 23.6 CKD [estimated glomerular
filtration rate {eGFR} < 60]) in the OPEN-CTO (Outcomes, Patients Health Status, and
Efficiency in Chronic Total Occlusions Registry) study. Hierarchical multivariable
regression models were used to examine the independent association of baseline eGFR
with technical success, periprocedural complications and change in health status,
using Seattle Angina Questionnaire (SAQ) over 1 year. Crude rates of acute kidney
injury were higher (13.5% vs 4.4%, p <0.001) and technical success lower (81.8% vs
88.4%, p = 0.01) in patients with CKD. There were no significant differences in other
periprocedural complications. After adjustment for confounding factors, there was
no significant association of baseline eGFR with technical success or periprocedural
major adverse cardiovascular and cerebral events (death, myocardial infarction, emergent
bypass surgery, stroke, perforation), whereas patients with lower eGFR had higher
rates of acute kidney injury. The difference in SAQ summary score, between patients
on the 10th and 90th percentile for baseline eGFR distribution was not clinically
significant (1 month: −0.91; 1 year: −3.06 points). In conclusion, CTO PCI success,
complication rates, and the health status improvement after CTO PCI are similar in
patients across a range of baseline eGFRs.
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Article info
Publication history
Published online: January 07, 2020
Received in revised form:
December 17,
2019
Received:
November 5,
2019
Footnotes
Funding: The OPEN CTO study was supported by an unrestricted grant from Boston Scientific (Marlborough, MA). The sponsor was not involved with the design of the analysis or with writing, reviewing or approval of the manuscript.
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