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Impact of minimum contrast media volumes during percutaneous coronary intervention for chronic total occlusion lesion

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Abstract

Contrast media exposure is associated with contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Aim of this study is to assess the utility of minimum contrast media volume (CMV ≤ 50 mL) during CTO-PCI for CIN prevention in patients with chronic kidney disease (CKD). We extracted data from the Japanese CTO-PCI expert registry; 2863 patients with CKD who underwent CTO-PCI performed from 2014 to 2020 were divided into two groups: minimum CMV (n = 191) and non-minimum CMV groups (n = 2672). CIN was defined as an increased serum creatinine level of ≥ 25% and/or ≥ 0.5 mg/dL compared with baseline levels within 72 h of the procedure. In the minimum CMV group, the CIN incidence was lower than that in the non-minimum CMV group (1.0% vs. 4.1%; p = 0.03). Patient success rate was higher and complication rate was lower in the minimum CMV group than in the non-minimum CMV group (96.8% vs. 90.3%; p = 0.02 and 3.1% vs. 7.1%; p = 0.03). In the minimum CMV group, the primary retrograde approach was more frequent in the case of J-CTO = 1,2 and 3–5 groups compared to that in non-minimum CMV-PCI group (J-CTO = 0; 11% vs. 17.7%, p = 0.06; J-CTO = 1; 22% vs. 35.8%, p = 0.01; J-CTO = 2; 32.4% vs. 46.5%, p = 0.01; and J-CTO = 3–5; 44.7% vs. 80.0%, p = 0.02). Minimum CMV-PCI for CTO in CKD patients could reduce the incidence of CIN. The primary retrograde approach was observed to a greater extent in the minimum CMV group, especially in cases of difficult CTO.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We are grateful to the members of the cardiac catheterization laboratories of the participating centers and the clinical research coordinators.

Funding

This study is funded by the Japanese board of Chronic Total Occlusion Interventional Specialist that is funded by Asahi Intecc, Abbott Vascular Japan, Biosensors Japan, Boston Scientific, Daiichi Sankyo, Kaneka Medix, Medtronic Japan, NIPRO, and Terumo.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan

    Soichiro Ebisawa

  2. Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki-Shi, Okayama, 710-8602, Japan

    Hiroyuki Tanaka

  3. Department of Cardiology, Tokyo Heart Center, Tokyo, Japan

    Toshiya Muramatsu

  4. Department of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan

    Koichi Kishi

  5. The Cardiovascular Institute, Tokyo, Japan

    Yuji Oikawa

  6. Division of Cardiology, Saitama Prefecture Cardiovascular and Respiratory Center, Saitama, Japan

    Makoto Muto

  7. Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan

    Hisayuki Okada

  8. Department of Cardiology, Shin-Koga Hospital, Fukuoka, Japan

    Tomohiro Kawasaki

  9. Director of Cardiology, Sanda City Hospital, Hyogo, Japan

    Ryohei Yoshikawa

  10. Division of Cardiology, Ootakanomori Hospital, Kashiwa, Japan

    Yuji Hamazaki

  11. Department of Cardiology, Toyohashi Heart Center, Aichi, Japan

    Etsuo Tsuchikane

  12. The Japanese CTO-PCI Expert Foundation, Okayama, Japan

    Etsuo Tsuchikane

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  1. Soichiro Ebisawa
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  2. Hiroyuki Tanaka
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  3. Toshiya Muramatsu
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  4. Koichi Kishi
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  6. Makoto Muto
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  9. Ryohei Yoshikawa
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  10. Yuji Hamazaki
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  11. Etsuo Tsuchikane
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Correspondence to Hiroyuki Tanaka.

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Ebisawa, S., Tanaka, H., Muramatsu, T. et al. Impact of minimum contrast media volumes during percutaneous coronary intervention for chronic total occlusion lesion. Heart Vessels 38, 1108–1116 (2023). https://doi.org/10.1007/s00380-023-02270-9

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  • DOI: https://doi.org/10.1007/s00380-023-02270-9

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