Lee Wei-Chieh, Wu Po-Jui, Fang Chih-Yuan, Chen Huang-Chung, Wu Chiung-Jen, Fang Hsiu-Yu
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 83301, Taiwan.
J Clin Med. 2021 Jan 23;10(3):440. doi: 10.3390/jcm10030440.
To examine the impact of revascularization and associated clinical outcomes of chronic kidney disease (CKD) chronic total occlusion (CTO) and non-CKD CTO groups.
The influence of CKD on clinical outcomes after percutaneous coronary intervention (PCI) for CTO lesions is unknown, and there is no systemic review of this topic to date.
We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials Databases for articles published between 1 January 2010 and 31 March 2020. CKD was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m according to the Modification of Diet in Renal Disease formula. Data included demographics, lesion distributions, incidence of contrast-induced nephropathy (CIN), acute kidney injury (AKI), procedural success rate, mortality, and target lesion revascularization (TLR)/target vessel revascularization (TVR).
Six studies were ultimately included in this systematic review. A high prevalence (25.5%; range, 19.6-37.9%) of CKD was noted in the CTO population. In the non-CKD group, outcomes were better: less incidence of CIN or AKI (odds ratio (OR), 2.860; 95% confidence interval (CI), 1.775-4.608), higher procedural success rate (OR, 1.382; 95% CI, 1.036-1.843), and lower long-term mortality (OR, 4.502; 95% CI, 3.561-5.693). The incidence of TLR/TVR (OR, 1.118; 95% CI, 0.888-1.407) did not differ between groups.
In the CKD CTO PCI population, a lower procedural success rate, a higher incidence of CIN or AKI, and higher in-hospital and long-term mortality rate were noted due to more complex lesions and more comorbidities. However, the incidence of TLR/TVR did not differ between groups.
探讨慢性肾脏病（CKD）慢性完全闭塞（CTO）组和非CKD CTO组血管重建的影响及相关临床结局。
CKD对CTO病变经皮冠状动脉介入治疗（PCI）后临床结局的影响尚不清楚，且迄今为止尚无关于该主题的系统评价。
我们检索了PubMed、Embase、ProQuest、ScienceDirect、Cochrane图书馆、ClinicalKey、科学网和临床试验数据库，以查找2010年1月1日至2020年3月31日期间发表的文章。根据肾脏病饮食改良公式，CKD定义为估计肾小球滤过率<60 mL/min/1.73 m²。数据包括人口统计学、病变分布、对比剂肾病（CIN）、急性肾损伤（AKI）的发生率、手术成功率、死亡率以及靶病变血管重建（TLR）/靶血管血管重建（TVR）。
本系统评价最终纳入6项研究。CTO人群中CKD的患病率较高（25.5%；范围为19.6%-37.9%）。在非CKD组中，结局较好：CIN或AKI的发生率较低（优势比（OR）为2.860；95%置信区间（CI）为1.775-4.608），手术成功率较高（OR为1.382；95%CI为1.036-1.843），长期死亡率较低（OR为4.502；95%CI为3.561-5.693）。两组间TLR/TVR的发生率（OR为1.118；95%CI为0.888-1.407）无差异。
在CKD CTO PCI人群中，由于病变更复杂且合并症更多，手术成功率较低，CIN或AKI的发生率较高，住院和长期死亡率也较高。然而，两组间TLR/TVR的发生率无差异。
