Hamzaraj Kevin, Demirel Caglayan, Gyöngyösi Mariann, Bartko Philipp E, Hengstenberg Christian, Frey Bernhard, Hemetsberger Rayyan
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria.
J Clin Med. 2024 Dec 16;13(24):7676. doi: 10.3390/jcm13247676.
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) requires advanced techniques and prolonged procedural efforts, often necessitating high contrast volumes, which may increase the risk of contrast-associated acute kidney injury (CA-AKI). However, evidence suggests that factors beyond contrast exposure contribute to CA-AKI, though data specific to CTO PCI remain limited. Patients undergoing contemporary CTO PCI at our university-affiliated tertiary care center were enrolled. CA-AKI was defined according to KDIGO criteria, and patients were stratified based on the presence of postprocedural CA-AKI. Baseline and procedural characteristics, including osmotic factors, were compared between the groups. The primary outcome was all-cause mortality at one year, and the secondary outcome was all-cause mortality at three years. A total of 145 patients were enrolled, with a mean age of 67 years, and 75% were male. Baseline creatinine levels, electrolytes, and osmotic factors did not differ significantly between groups. Lesion parameters and J-CTO scores were also comparable. The contrast volume and procedural duration were numerically higher in patients who developed CA-AKI. Patients with CA-AKI received a higher radiation dose (22.1 vs. 13.2 Gy·cm, = 0.041). CA-AKI emerged as an independent predictor of all-cause mortality at one year (adjusted HR 5.3, CI [1.52-18.51], = 0.009) but not at three years. In this retrospective analysis, CA-AKI was an independent predictor of all-cause mortality at one year following CTO PCI but lost predictive value at three years. Baseline renal function and contrast volume alone did not predict CA-AKI. Instead, procedural complexity, reflected by higher radiation exposure, was associated with an elevated risk of CA-AKI.
慢性完全闭塞病变（CTO）的经皮冠状动脉介入治疗（PCI）需要先进的技术和长时间的操作，通常需要大量造影剂，这可能会增加造影剂相关急性肾损伤（CA-AKI）的风险。然而，有证据表明，除造影剂暴露外的其他因素也会导致CA-AKI，尽管CTO PCI的具体数据仍然有限。我们大学附属医院三级医疗中心接受当代CTO PCI的患者被纳入研究。CA-AKI根据KDIGO标准定义，患者根据术后是否发生CA-AKI进行分层。比较两组之间的基线和操作特征，包括渗透因素。主要结局是1年时的全因死亡率，次要结局是3年时的全因死亡率。共纳入145例患者，平均年龄67岁，75%为男性。两组之间的基线肌酐水平、电解质和渗透因素无显著差异。病变参数和J-CTO评分也具有可比性。发生CA-AKI的患者造影剂用量和操作时间在数值上更高。发生CA-AKI的患者接受的辐射剂量更高（22.1 vs. 13.2 Gy·cm，P = 0.041）。CA-AKI是1年时全因死亡率的独立预测因素（校正后HR 5.3，CI [1.52 - 18.51]，P = 0.009），但不是3年时的独立预测因素。在这项回顾性分析中，CA-AKI是CTO PCI术后1年全因死亡率的独立预测因素，但在3年时失去预测价值。仅基线肾功能和造影剂用量并不能预测CA-AKI。相反，较高的辐射暴露所反映的操作复杂性与CA-AKI风险升高相关。
