Influence of chronic kidney disease on the outcome of patients with chronic total occlusion.

ABSTRACT

OBJECTIVE: Chronic kidney disease (CKD) predicted a poor prognosis in patients with coronary artery disease. There is a paucity of data on outcomes after revascularization in patients with chronic total occlusion (CTO) and CKD. This study aims to investigate the impact of CKD on the revascularization of CTO. METHODS: This study enrolled 1,092 CTO patients received treatments in our hospital between February 2009 and January 2014. Major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality were compared to evaluate medium- and long-term outcomes. Median follow-up was 39 months (interquartile range, 27-52 months). RESULT: CKD decreased cumulative MACCE-free survival rate (54.4 ± 6.2% vs. 70.9 ± 2.5%, P < 0.001) and cumulative survival rate (68.6 ± 6.3% vs. 90.5 ± 1.6%, P < 0.001). Revascularization was associated with better outcomes among patients with (MACCE-free survival rate 64.8 ± 5.7% vs. 20.1 ± 15.3%, P = 0.009; survival rate 78.4 ± 5.6% vs. 38.7 ± 17.4%, P = 0.006) or without CKD (MACCE-free survival rate 73.9 ± 2.7% vs. 61.0 ± 5.4%, P = 0.001; survival rate 92.9 ± 1.5% vs. 83.8 ± 4.0%, P = 0.009). The benefit from revascularization was attenuated by CKD. Compared with percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) had similar cumulative survival rates among patients, whether with or without CKD, but was associated with a higher cumulative MACCE-free survival rate (80.5 ± 3.4% vs. 68.5 ± 4.0%, P = 0.017) among patients without CKD. CONCLUSION: CKD attenuated the benefit from revascularization for CTO. Moreover, CABG was not superior to PCI among CTO patients, but with a reduction in MACCE in patients without CKD.