Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan.
Division Cardiology, Department of Medicine, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York.
Coron Artery Dis. 2021 Dec 1;32(8):681-688. doi: 10.1097/MCA.0000000000001026.
The relative safety and efficacy of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in patients with chronic kidney disease (CKD) have not been well defined. We performed a systematic review and meta-analysis of observational studies to assess in-hospital outcomes in this population.
We searched MEDLINE, EMBASE, and Cochrane Library databases from inception to April 2020 for all clinical trials and observational studies. Five observational studies with a total of 6769 patients met our inclusion criteria. Patients were divided into two groups based on estimated glomerular filtration rate (eGFR <60 ml/min/1.73m2 in CKD group and ≥ 60 ml/min/1.73m2 in non-CKD group). The primary outcome was in-hospital mortality. Secondary outcomes were acute kidney injury, coronary injury (perforation, dissection or tamponade), stroke and procedural success. Mantel-Haenszel random-effects model was used to calculate the odds ratio (OR) and 95% confidence intervals (CI).
In-hospital mortality was significantly higher among patients with CKD undergoing PCI for CTO (OR: 5.16, 95% CI: 2.60-10.26, P < 0.00001). Acute kidney injury (OR: 2.54, 95% CI: 1.89-3.40, P < 0.00001) and major bleeding (OR: 2.58, 95% CI: 1.20-5.54, P < 0.01) were also more common in the CKD group. No significant difference was observed in the occurrence of stroke (OR: 2.36, 95% CI: 0.74-7.54, P < 0.15) or coronary injury (OR: 1.38, 95% CI: 0.98-1.93, P < 0.06) between the two groups. Non-CKD patients had a higher likelihood of procedural success compared to CKD patients (OR: 0.66, 95% CI: 0.57-0.77, P < 0.00001).
Patients with CKD undergoing PCI for CTO have a significantly higher risk of in-hospital mortality, acute kidney injury and major bleeding when compared to non-CKD patients. They also have a lower procedural success rate.
经皮冠状动脉介入治疗（PCI）治疗慢性肾脏病（CKD）患者慢性完全闭塞（CTO）的相对安全性和疗效尚未明确。我们对观察性研究进行了系统评价和荟萃分析，以评估该人群的住院结局。
我们从 MEDLINE、EMBASE 和 Cochrane 图书馆数据库中检索了从成立到 2020 年 4 月的所有临床试验和观察性研究。共有 5 项观察性研究，总计 6769 例患者符合纳入标准。根据估计肾小球滤过率（CKD 组 eGFR<60ml/min/1.73m2，非 CKD 组 eGFR≥60ml/min/1.73m2）将患者分为两组。主要结局为住院死亡率。次要结局为急性肾损伤、冠状动脉损伤（穿孔、夹层或填塞）、卒中和手术成功率。采用 Mantel-Haenszel 随机效应模型计算比值比（OR）和 95%置信区间（CI）。
CKD 患者行 CTO-PCI 后住院死亡率显著升高（OR：5.16，95%CI：2.60-10.26，P<0.00001）。CKD 组急性肾损伤（OR：2.54，95%CI：1.89-3.40，P<0.00001）和主要出血（OR：2.58，95%CI：1.20-5.54，P<0.01）也更为常见。两组间卒中（OR：2.36，95%CI：0.74-7.54，P<0.15）或冠状动脉损伤（OR：1.38，95%CI：0.98-1.93，P<0.06）的发生率无显著差异。与 CKD 患者相比，非 CKD 患者手术成功率更高（OR：0.66，95%CI：0.57-0.77，P<0.00001）。
与非 CKD 患者相比，CKD 患者行 CTO-PCI 的住院死亡率、急性肾损伤和主要出血风险显著升高，手术成功率也较低。
