Revascularization vs. Medical Therapy for Coronary Chronic Total Occlusions in Patients With Chronic Kidney Disease.

Abstract

BACKGROUND:

We investigated whether the outcome of revascularization differed from the outcome of medical therapy in chronic kidney disease (CKD) and non-CKD patients with chronic total occlusion (CTO).Methods and Results:A total of 2,010 patients with CTO who underwent revascularization (n=1,355), including percutaneous coronary intervention (n=878) and coronary artery bypass grafting (n=477), or had medical therapy alone (n=655) were examined. The primary outcome was all-cause death during follow-up. Among the non-CKD patients (n=1,679), revascularization had a lower incidence of all-cause death (adjusted hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.41-0.72, P<0.001) compared with medical therapy. Among the CKD patients (n=331), the difference in the incidence of all-cause death was not as marked between the 2 treatments (adjusted HR 0.71, 95% CI 0.48-1.06, P=0.09). There was a significant interaction between kidney function and treatment strategy (revascularization vs. medical therapy) on all-cause death (P for interaction=0.014).

CONCLUSIONS:

Based on the clinical outcomes, in CTO patients with preexisting CKD, revascularization via PCI or bypass surgery might not be as effective as in non-CKD patients.

• Authors: Chung Hun Kim, Jeong Hoon Yang, Taek Kyu Park, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Sang Hoon Lee, Hyeon-Cheol Gwon, Joonghyun Ahn, Keumhee Chough Carriere, Seung-Hyuk Choi
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 82 Issue 8 Pg. 2136-2142 (07 25 2018) ISSN: 1347-4820 [Electronic] Japan
• PMID: 29899202 (Publication Type: Journal Article)

Chemical References

• Hematologic Agents

Topics

• Aged
• Aged, 80 and over
• Cause of Death
• Coronary Artery Bypass (methods)
• Coronary Occlusion (drug therapy, etiology, surgery, therapy)
• Female
• Hematologic Agents (therapeutic use)
• Humans
• Male
• Middle Aged
• Myocardial Revascularization (mortality, trends)
• Percutaneous Coronary Intervention (methods)
• Renal Insufficiency, Chronic (complications)
• Treatment Outcome