Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain.
Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain; ABC Medical Center, Mexico City, Mexico.
Cardiovasc Revasc Med. 2022 May;38:75-80. doi: 10.1016/j.carrev.2021.07.018. Epub 2021 Jul 21.
Data on the impact of chronic kidney disease (CKD) on clinical outcomes in chronic total occlusion (CTO) patients is scarce, and the optimal treatment strategy for this population is not well established. This study aims to compare differences in CTO management and long-term clinical outcomes, including all-cause and cardiac mortalities, according to baseline glomerular filtration rate (GFR).
All patients with at least one CTO diagnosed in our center between 2010 and 2014 were included. Demographic and clinical data were registered. All-cause and cardiac mortalities were assessed during a median follow-up of 4.03 years (IQR 2.6-4.8). Clinical outcomes were compared between patients with CKD (GFR < 60 mL/min/1.73 m) and without CKD (GFR ≥ 60 mL/min/1.73 m).
A total of 1248 patients (67.3 ± 10.9 years; 32% CKD) were identified. CKD patients were older and had a higher prevalence of hypertension, type 2 diabetes, peripheral arterial disease, and severe left ventricular dysfunction compared to patients with normal renal function (p < 0.05). Subjects with renal dysfunction were more often treated with MT alone, compared to patients without CKD (63% vs 45%; p < 0.001), who were more likely to undergo PCI or surgery. During follow-up, 386 patients [31%] died. CKD patients had a higher rate of all-cause and cardiac mortalities compared to patients without CKD (p < 0.001). The independent predictors for all-cause mortality were age, GFR < 60 mL/min/1.73 m, Syntax Score I, and successful revascularization of the CTO (CABG or PCI-CTO). Among patients with CKD, advanced age, eGFR <30 mL/min/1.73 m, and CTO successful revascularization were predictors of all-cause mortality.
Patients with CKD were more often treated with MT alone. At long-term follow-up, revascularization of the CTO is associated with lower all-cause and cardiac mortalities in this population.
关于慢性肾脏病（CKD）对慢性完全闭塞（CTO）患者临床结局影响的数据很少，并且该人群的最佳治疗策略尚未确定。本研究旨在比较根据基线肾小球滤过率（GFR），CTO 管理和长期临床结局（包括全因和心脏死亡率）的差异。
纳入 2010 年至 2014 年间在我们中心至少诊断出一条 CTO 的所有患者。记录人口统计学和临床数据。在中位数为 4.03 年（IQR 2.6-4.8）的随访期间评估全因和心脏死亡率。将 CKD（GFR <60 mL/min/1.73 m）和非 CKD（GFR ≥60 mL/min/1.73 m）患者的临床结局进行比较。
共纳入 1248 例患者（67.3 ± 10.9 岁；32%的 CKD）。与肾功能正常的患者相比，CKD 患者年龄更大，高血压、2 型糖尿病、外周动脉疾病和严重左心室功能障碍的患病率更高（p <0.05）。与肾功能正常的患者相比，肾功能障碍患者更常单独接受 MT 治疗（63%比 45%；p <0.001），而前者更可能接受 PCI 或手术治疗。随访期间，386 例患者（31%）死亡。与无 CKD 的患者相比，CKD 患者的全因和心脏死亡率更高（p <0.001）。全因死亡率的独立预测因素为年龄、GFR <60 mL/min/1.73 m、Syntax 评分 I 和 CTO 的成功血运重建（CABG 或 PCI-CTO）。在 CKD 患者中，高龄、eGFR <30 mL/min/1.73 m 和 CTO 的成功血运重建是全因死亡率的预测因素。
CKD 患者更常单独接受 MT 治疗。在长期随访中，该人群的 CTO 血运重建与较低的全因和心脏死亡率相关。
