Impact of hemodialysis on procedural outcomes of percutaneous coronary intervention for chronic total occlusion

Insights from the Japanese multicenter registry

Tatsuya Nakachi, Shun Kosaka, Masahisa Yamane, Toshiya Muramatsu, Atsunori Okamura, Yoshifumi Kashima, Shunsuke Matsuno, Masami Sakurada, Mikihiko Kijima, Masaki Tanabe, Maoto Habara

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Article numbere006431
JournalJournal of the American Heart Association
Volume6
Issue number10
DOIs
Publication statusPublished - 2017 Oct 1

Fingerprint

Percutaneous Coronary Intervention
Registries
Renal Dialysis
Odds Ratio
Confidence Intervals
Patient Selection
Diabetes Mellitus
Morbidity
Mortality

Keywords

  • Chronic total coronary occlusion
  • Hemodialysis
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of hemodialysis on procedural outcomes of percutaneous coronary intervention for chronic total occlusion : Insights from the Japanese multicenter registry. / Nakachi, Tatsuya; Kosaka, Shun; Yamane, Masahisa; Muramatsu, Toshiya; Okamura, Atsunori; Kashima, Yoshifumi; Matsuno, Shunsuke; Sakurada, Masami; Kijima, Mikihiko; Tanabe, Masaki; Habara, Maoto.

In: Journal of the American Heart Association, Vol. 6, No. 10, e006431, 01.10.2017.

Research output: Contribution to journalArticle

Nakachi, Tatsuya ; Kosaka, Shun ; Yamane, Masahisa ; Muramatsu, Toshiya ; Okamura, Atsunori ; Kashima, Yoshifumi ; Matsuno, Shunsuke ; Sakurada, Masami ; Kijima, Mikihiko ; Tanabe, Masaki ; Habara, Maoto. / Impact of hemodialysis on procedural outcomes of percutaneous coronary intervention for chronic total occlusion : Insights from the Japanese multicenter registry. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 10.
@article{e1c7e1ed736145458cffcf049d4138ba,
title = "Impact of hemodialysis on procedural outcomes of percutaneous coronary intervention for chronic total occlusion: Insights from the Japanese multicenter registry",
abstract = "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.",
keywords = "Chronic total coronary occlusion, Hemodialysis, Percutaneous coronary intervention",
author = "Tatsuya Nakachi and Shun Kosaka and Masahisa Yamane and Toshiya Muramatsu and Atsunori Okamura and Yoshifumi Kashima and Shunsuke Matsuno and Masami Sakurada and Mikihiko Kijima and Masaki Tanabe and Maoto Habara",
year = "2017",
month = "10",
day = "1",
doi = "10.1161/JAHA.117.006431",
language = "English",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - Impact of hemodialysis on procedural outcomes of percutaneous coronary intervention for chronic total occlusion

T2 - Insights from the Japanese multicenter registry

AU - Nakachi, Tatsuya

AU - Kosaka, Shun

AU - Yamane, Masahisa

AU - Muramatsu, Toshiya

AU - Okamura, Atsunori

AU - Kashima, Yoshifumi

AU - Matsuno, Shunsuke

AU - Sakurada, Masami

AU - Kijima, Mikihiko

AU - Tanabe, Masaki

AU - Habara, Maoto

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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.

AB - 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.

KW - Chronic total coronary occlusion

KW - Hemodialysis

KW - Percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85032187987&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032187987&partnerID=8YFLogxK

U2 - 10.1161/JAHA.117.006431

DO - 10.1161/JAHA.117.006431

M3 - Article

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 10

M1 - e006431

ER -