Impact of chronic kidney disease on in-hospital outcomes among patients undergoing percutaneous coronary intervention for chronic total occlusions.

BACKGROUND

Approximately one-tenth of patients undergoing percutaneous coronary intervention (PCI) of a chronic total occlusion(CTO) have chronic kidney disease (CKD). There are limited data on outcomes in patients with CKD undergoing elective CTO PCI and our aim was to investigate the short-term outcomes of these patients.

METHODS

We utilized Nationwide Inpatient Sample (NIS) database (years 2010-11) to identify all hospitalizations associated with elective single-vessel CTO PCI. Afterwards, patients were categorized into two groups according to CKD status, with the CKD group further stratified by stage. Primary outcome was in-hospital mortality and secondary outcomes were periprocedural complications. We also investigated the length of hospital stay and costs. Discharge weights were used to produce national estimates.

RESULTS

We identified 6164 adult patients who underwent single-vessel CTO PCI. There were 604 patients (9.85 %) with CKD. They were older, with higher prevalence of hypertension, diabetes mellitus, atrial fibrillation, peripheral artery disease and chronic obstructive pulmonary disease. CKD was independently associated with higher in-hospital mortality, demonstrating a 74 % increase in odds per category (non-CKD, moderate-severe CKD [encompassing CKD stage 3-5] and end-stage renal disease requiring chronic dialysis). Patients with CKD had significantly higher rates of periprocedural myocardial infarction, acute kidney injury (AKI) and need for initiation of dialysis, as well as composite outcome of periprocedural complications. Consequently, this resulted in longer hospital stay and higher hospitalization costs.

CONCLUSION

CKD is independently associated with higher in-hospital mortality among patients undergoing elective single-vessel CTO PCI, demonstrating increasing odds with worsening CKD. Presence of CKD is associated with a higher rate of periprocedural complications, prolonged hospital stay and increased hospitalization costs.