Open AccessImpact of Hemodialysis on Procedural Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion: Insights From the Japanese Multicenter Registry
Author(s) -
Nakachi Tatsuya,
Kohsaka Shun,
Yamane Masahisa,
Muramatsu Toshiya,
Okamura Atsunori,
Kashima Yoshifumi,
Matsuno Shunsuke,
Sakurada Masami,
Kijima Mikihiko,
Tanabe Masaki,
Habara Maoto
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.006431
Subject(s) - medicine , percutaneous coronary intervention , hemodialysis , multicenter study , coronary occlusion , conventional pci , cardiology , emergency medicine , occlusion , myocardial infarction , randomized controlled trial
Background Among patients treated with percutaneous coronary intervention for chronic total occlusion ( CTO ‐ PCI ), patients on long‐term hemodialysis are at significantly high risk for cardiovascular mortality and morbidity. However, clinical or angiographic predictors that might aid in better patient selection remain unclear. We aimed to assess the acute impact of hemodialysis in patients who underwent CTO ‐ PCI . Methods and Results The Retrograde Summit registry is a multicenter, prospective registry of patients undergoing CTO ‐ PCI at 65 Japanese centers. Patient characteristics and procedural outcomes of 4749 patients were analyzed, according to the presence (n=313) or absence (n=4436) of baseline hemodialysis. A prediction model for technical failure among hemodialysis patients was also developed. The technical success rate of CTO ‐ PCI was significantly lower in hemodialysis than in nonhemodialysis patients (78.0% versus 89.1%, P <0.001). The rates of in‐hospital major adverse cardiac and cerebrovascular events were similar between the 2 groups (1.6% versus 0.9%, P =0.24). Irrespective of clinical/angiographic characteristics or previously developed scoring systems, hemodialysis independently predicted technical failure for CTO ‐ PCI . Among hemodialysis patients, predictors of technical failure were blunt stump (odds ratio 2.45, 95% confidence interval, 1.15–5.21, P =0.021), severe lesion calcification (odds ratio 2.50, 95% confidence interval, 1.19–5.24, P =0.015), and absence of diabetes mellitus (odds ratio 3.15, 95% confidence interval, 1.49–6.64, P =0.003). In hemodialysis patients without these predictors, the technical success rate was 96.2%. Conclusions Hemodialysis is significantly associated with technical failure. Contemporary CTO ‐ PCI seems feasible and safe in selected hemodialysis patients.