Impact of minimum contrast media volumes during percutaneous coronary intervention for chronic total occlusion lesion

• Published in: Heart and vessels Vol. 38; no. 9; pp. 1108 - 1116
• Main Authors: Ebisawa, Soichiro, Tanaka, Hiroyuki, Muramatsu, Toshiya, Kishi, Koichi, Oikawa, Yuji, Muto, Makoto, Okada, Hisayuki, Kawasaki, Tomohiro, Yoshikawa, Ryohei, Hamazaki, Yuji, Tsuchikane, Etsuo
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.09.2023; Springer Nature B.V
• Subjects: Angioplasty; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Contrast agents; Contrast media; Creatinine; Kidney diseases; Medicine; Medicine & Public Health; Nephropathy; Occlusion; Original Article; Vascular Surgery; Chronic total occlusion; Percutaneous coronary intervention; Contrast-induced nephropathy
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-023-02270-9

Contrast media exposure is associated with contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Aim of this study is to assess the utility of minimum contrast media volume (CMV ≤ 50 mL) during CTO-PCI for CIN prevention in patients with chronic kidney disease (CKD). We extracted data from the Japanese CTO-PCI expert registry; 2863 patients with CKD who underwent CTO-PCI performed from 2014 to 2020 were divided into two groups: minimum CMV ( n  = 191) and non-minimum CMV groups ( n  = 2672). CIN was defined as an increased serum creatinine level of ≥ 25% and/or ≥ 0.5 mg/dL compared with baseline levels within 72 h of the procedure. In the minimum CMV group, the CIN incidence was lower than that in the non-minimum CMV group (1.0% vs. 4.1%; p  = 0.03). Patient success rate was higher and complication rate was lower in the minimum CMV group than in the non-minimum CMV group (96.8% vs. 90.3%; p  = 0.02 and 3.1% vs. 7.1%; p  = 0.03). In the minimum CMV group, the primary retrograde approach was more frequent in the case of J-CTO = 1,2 and 3–5 groups compared to that in non-minimum CMV-PCI group (J-CTO = 0; 11% vs. 17.7%, p  = 0.06; J-CTO = 1; 22% vs. 35.8%, p  = 0.01; J-CTO = 2; 32.4% vs. 46.5%, p  = 0.01; and J-CTO = 3–5; 44.7% vs. 80.0%, p  = 0.02). Minimum CMV-PCI for CTO in CKD patients could reduce the incidence of CIN. The primary retrograde approach was observed to a greater extent in the minimum CMV group, especially in cases of difficult CTO.