Skip to main content

Advertisement

SpringerLink
Log in

Impact of impaired renal function on outcomes of chronic total occlusion undergoing revascularization: a systemic review and meta-analysis

  • Nephrology - Review
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Patients with chronic kidney disease (CKD) have an associated burden of coronary artery disease, including chronic total occlusions (CTO). It is unclear how the presence of CKD affects the outcomes of CTO revascularization. Previous reviews have not taken into account all relevant published studies that examined the association of CKD with outcomes of CTO revascularization.

Methods

A systematic search was conducted using PubMed, Scopus, and Google Scholar databases for studies investigating patients with or without CKD who also had coronary chronic total occlusion undergoing revascularization procedures Statistical analysis was performed using STATA software. Effect sizes were reported as pooled relative risk (RR).

Results

A total of 13 studies were included. CKD patients showed elevated risk of in-hospital mortality (RR 4.25, 95% CI 2.64, 6.82) and mortality at latest follow-up (RR 3.24, 95% CI 2.56, 4.11), elevated risk of major cardio or cerebrovascular events (RR 1.65, 95% CI 1.38, 1.98), major bleeding (RR 2.85, 95% CI 1.96, 4.13), and contrast-induced acute kidney injury (RR 3.06, 95% CI 1.70, 5.52). CKD patients also showed lower chances of technical success (RR 0.95, 95% CI 0.91, 1.00).

Conclusions

The presence of CKD increases the risk of mortality, complications and adversely affects the success of CTO revascularization. Patients with CKD undergoing revascularization should have their kidney function comprehensively evaluated and these patients should be carefully monitored.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

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

References

  1. Werner GS, Gitt AK, Zeymer U et al (2009) Chronic total coronary occlusions in patients with stable angina pectoris: impact on therapy and outcome in present day clinical practice. Clin Res Cardiol 98:435–441. https://doi.org/10.1007/s00392-009-0013-5

    Article  PubMed  Google Scholar 

  2. Irving J (2014) CTO pathophysiology: how does this affect management? Curr Cardiol Rev 10:99–107. https://doi.org/10.2174/1573403x10666140331142349

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kearney K, Hira RS, Riley RF et al (2017) Update on the management of chronic total occlusions in coronary artery disease. Curr Atheroscler Rep 19:19. https://doi.org/10.1007/s11883-017-0655-0

    Article  PubMed  Google Scholar 

  4. Weintraub WS, Garratt KN (2016) Should chronic total occlusion be treated with coronary artery bypass grafting? Circulation 133:1818–1825. https://doi.org/10.1161/CIRCULATIONAHA.115.017798

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ybarra LF, Cantarelli MJC, Lemke VMG, de Quadros AS (2018) Percutaneous coronary intervention in chronic total occlusion. Arq Bras Cardiol 110:476–483. https://doi.org/10.5935/abc.20180077

    Article  PubMed  PubMed Central  Google Scholar 

  6. Subbiah AK, Chhabra YK, Mahajan S (2016) Cardiovascular disease in patients with chronic kidney disease: a neglected subgroup. Heart Asia 8:56–61. https://doi.org/10.1136/heartasia-2016-010809

    Article  PubMed  PubMed Central  Google Scholar 

  7. Briasoulis A, Bakris GL (2013) Chronic kidney disease as a coronary artery disease risk equivalent. Curr Cardiol Rep 15:340. https://doi.org/10.1007/s11886-012-0340-4

    Article  PubMed  Google Scholar 

  8. Cooper WA, O’Brien SM, Thourani VH et al (2006) Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 113:1063–1070. https://doi.org/10.1161/CIRCULATIONAHA.105.580084

    Article  PubMed  Google Scholar 

  9. Tsai TT, Messenger JC, Brennan JM et al (2011) Safety and efficacy of drug-eluting stents in older patients with chronic kidney disease: a report from the linked CathPCI registry-CMS claims database. J Am Coll Cardiol 58:1859–1869. https://doi.org/10.1016/j.jacc.2011.06.056

    Article  CAS  PubMed  Google Scholar 

  10. Muntner P, He J, Hamm L et al (2002) Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 13:745–753. https://doi.org/10.1681/ASN.V133745

    Article  PubMed  Google Scholar 

  11. Campbell NG, Varagunam M, Sawhney V et al (2012) Mild chronic kidney disease is an independent predictor of long-term mortality after emergency angiography and primary percutaneous intervention in patients with ST-elevation myocardial infarction. Heart 98:42–47. https://doi.org/10.1136/heartjnl-2011-300024

    Article  PubMed  Google Scholar 

  12. Giustino G, Mehran R, Serruys PW et al (2018) Left main revascularization with PCI or CABG in Patients with chronic kidney disease: EXCEL trial. J Am Coll Cardiol 72:754–765. https://doi.org/10.1016/j.jacc.2018.05.057

    Article  PubMed  Google Scholar 

  13. Sarnak MJ, Levey AS, Schoolwerth AC et al (2003) Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Hypertension 42:1050–1065. https://doi.org/10.1161/01.HYP.0000102971.85504.7c

    Article  CAS  PubMed  Google Scholar 

  14. Wali RK, Henrich WL (2005) Chronic kidney disease: a risk factor for cardiovascular disease. Cardiol Clin 23:343–362. https://doi.org/10.1016/j.ccl.2005.03.007

    Article  PubMed  Google Scholar 

  15. Levey AS, Beto JA, Coronado BE et al (1998) Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease. Am J Kidney Dis 32:853–906. https://doi.org/10.1016/s0272-6386(98)70145-3

    Article  CAS  PubMed  Google Scholar 

  16. Aktürk E, Aşkın L, Taşolar H et al (2019) Evaluation of contrast nephropathy in percutaneous treatment of chronic total occlusions. Interv Med Appl Sci 11:95–100. https://doi.org/10.1556/1646.11.2019.15

    Article  PubMed  PubMed Central  Google Scholar 

  17. Moroni F, Spangaro A, Carlino M et al (2020) Impact of renal function on the immediate and long-term outcomes of percutaneous recanalization of coronary chronic total occlusions: a systematic review and meta-analysis. Int J Cardiol 317:200–206. https://doi.org/10.1016/j.ijcard.2020.05.067

    Article  PubMed  Google Scholar 

  18. Farrukh Mustafa S, Zafar MR, Vira A et al (2021) In-hospital outcomes of patients with chronic kidney disease undergoing percutaneous coronary intervention for chronic total occlusion: a systematic review and meta-analysis. Coron Artery Dis. https://doi.org/10.1097/MCA.0000000000001026

    Article  PubMed  Google Scholar 

  19. Lee W-C, Wu P-J, Fang C-Y et al (2021) Impact of chronic kidney disease on chronic total occlusion revascularization outcomes: a meta-analysis. J Clin Med 10:440. https://doi.org/10.3390/jcm10030440

    Article  PubMed  PubMed Central  Google Scholar 

  20. PRISMA. http://www.prisma-statement.org/PRISMAStatement/. Accessed 11 Sep 2021

  21. Wells G, Shea B, O’Connell D, et al The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. 21

  22. Higgins JPT, Green S Cochrane Handbook for Systematic Reviews of Interventions. https://handbook-5-1.cochrane.org/. Accessed 22 Aug 2021

  23. Malik AO, Spertus JA, Grantham JA et al (2020) Outcomes of chronic total occlusion percutaneous coronary intervention in patients with renal dysfunction. Am J Cardiol 125:1046–1053. https://doi.org/10.1016/j.amjcard.2019.12.045

    Article  PubMed  PubMed Central  Google Scholar 

  24. Guo L, Ding H, Lv H et al (2020) Impact of renal function on long-term clinical outcomes in patients with coronary chronic total occlusions: results from an observational single-center cohort study during the last 12 years. Front Cardiovasc Med 7:550428. https://doi.org/10.3389/fcvm.2020.550428

    Article  PubMed  PubMed Central  Google Scholar 

  25. Li B, Rong J, Wang B et al (2020) Cystatin C-based renal function in predicting the long-term outcomes of chronic total occlusion after percutaneous coronary intervention. Front Cardiovasc Med 7:221. https://doi.org/10.3389/fcvm.2020.586181

    Article  CAS  Google Scholar 

  26. Flores-Umanzor E, Cepas-Guillen P, Álvarez-Contreras L et al (2021) Impact of chronic kidney disease in chronic total occlusion management and clinical outcomes. Cardiovasc Revasc Med S1553–8389(21):00545–00555. https://doi.org/10.1016/j.carrev.2021.07.018

    Article  Google Scholar 

  27. Shimura T, Yamamoto M, Tsuchikane E et al (2016) Rates of future hemodialysis risk and beneficial outcomes for patients with chronic kidney disease undergoing recanalization of chronic total occlusion. Int J Cardiol 222:707–713. https://doi.org/10.1016/j.ijcard.2016.08.019

    Article  PubMed  Google Scholar 

  28. Azzalini L, Ojeda S, Demir OM et al (2018) Recanalization of chronic total occlusions in patients with vs without chronic kidney disease: the impact of contrast-induced acute kidney injury. Can J Cardiol 34:1275–1282. https://doi.org/10.1016/j.cjca.2018.07.012

    Article  PubMed  Google Scholar 

  29. Tajti P, Karatasakis A, Danek BA et al (2018) In-hospital outcomes of chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease. J Invasive Cardiol 30:E113–E121

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  31. Aguiar-Souto P, Ferrante G, Del Furia F et al (2010) Frequency and predictors of contrast-induced nephropathy after angioplasty for chronic total occlusions. Int J Cardiol 139:68–74. https://doi.org/10.1016/j.ijcard.2008.10.006

    Article  PubMed  Google Scholar 

  32. Lin Y-S, Fang H-Y, Hussein H et al (2014) Predictors of contrast-induced nephropathy in chronic total occlusion percutaneous coronary intervention. EuroIntervention 9:1173–1180. https://doi.org/10.4244/EIJV9I10A198

    Article  PubMed  Google Scholar 

  33. Zhang Q-B, Chen L-M, Li M et al (2016) Influence of chronic kidney disease on the outcome of patients with chronic total occlusion. Am J Transl Res 8:196–208

    PubMed  PubMed Central  Google Scholar 

  34. Naganuma T, Tsujita K, Mitomo S et al (2018) Impact of chronic kidney disease on outcomes after percutaneous coronary intervention for chronic total occlusions (from the Japanese Multicenter Registry). Am J Cardiol 121:1519–1523. https://doi.org/10.1016/j.amjcard.2018.02.032

    Article  PubMed  Google Scholar 

  35. Scholz SS, Lauder L, Ewen S et al (2020) One-year clinical outcomes in patients with renal insufficiency after contemporary PCI: data from a multicenter registry. Clin Res Cardiol 109:845–856. https://doi.org/10.1007/s00392-019-01575-y

    Article  CAS  PubMed  Google Scholar 

  36. Tonelli M, Wiebe N, Culleton B et al (2006) Chronic kidney disease and mortality risk: a systematic review. JASN 17:2034–2047. https://doi.org/10.1681/ASN.2005101085

    Article  PubMed  Google Scholar 

  37. Shlipak MG, Fried LF, Crump C et al (2003) Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency. Circulation 107:87–92. https://doi.org/10.1161/01.cir.0000042700.48769.59

    Article  CAS  PubMed  Google Scholar 

  38. Raggi P, Boulay A, Chasan-Taber S et al (2002) Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol 39:695–701. https://doi.org/10.1016/s0735-1097(01)01781-8

    Article  PubMed  Google Scholar 

  39. McCullough PA, Adam A, Becker CR et al (2006) Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol 98:5K-13K. https://doi.org/10.1016/j.amjcard.2006.01.019

    Article  CAS  PubMed  Google Scholar 

  40. Tsai TT, Patel UD, Chang TI et al (2014) Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv 7:1–9. https://doi.org/10.1016/j.jcin.2013.06.016

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

No funding was received.

Author information

Author notes

  1. Yonghui Qi and Jiqing He have contributed equally to the manuscript.

Authors and Affiliations

  1. Blood Purification Center of Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, No.19 Xiuhua Road, Xiuying District, Haikon City, Hianan Province, China

    Yonghui Qi, Jiqing He & Mingjiao Pan

  2. Department of Cardiovascular Medicine, Sanya Peoples Hospital, West China Sanya Hospital of Sichuan University, No.558 Jiefang Road, Sanya City, Hainan Province, China

    Jun Yan

Authors
  1. Yonghui Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jiqing He
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mingjiao Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jun Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YQ and JH conceptualized and designed the study; YQ and JH did literature search and data collection; MP and JY analysed the data; MP and JY wrote the paper; YQ and JH Reviewed and edited the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jun Yan.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 127 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qi, Y., He, J., Pan, M. et al. Impact of impaired renal function on outcomes of chronic total occlusion undergoing revascularization: a systemic review and meta-analysis. Int Urol Nephrol 54, 3179–3191 (2022). https://doi.org/10.1007/s11255-022-03192-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-022-03192-7

Keywords

Search

Navigation