title: Interaction of chronic total occlusion and chronic kidney disease in patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.
abstract: Chronic total occlusion (CTO) in a non-infarct-related artery and chronic kidney failure (CKD) are associated with worse outcomes after primary percutaneous coronary intervention (PCI). The aim of this study was to investigate the interaction of CTO and CKD in patients who underwent primary PCI for acute ST-segment elevation myocardial infarction (STEMI). Patients with STEMIs with or without CKD, defined as an estimated glomerular filtration rate <60 ml/min/1.73 m(2), were categorized into those with single-vessel disease and those with multivessel disease with or without CTO. The primary outcomes were the incidence of 30-day and 1-year mortality. Among 1,873 consecutive patients with STEMIs included between 2006 and 2011, 336 (18%) had CKD. The prevalence of CTO in a non-infarct-related artery was 13% in patients with CKD compared with 7% in those without CKD (p = 0.0003). There was a significant interaction between CKD and CTO on 30-day mortality (p = 0.018) and 1-year mortality (p = 0.013). Independent predictors of late mortality in patients with CKD were previous myocardial infarction (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.01 to 2.79), age >75 years (HR 1.86, 95% CI 1.19 to 2.95), a left ventricular ejection fraction after primary PCI <40% (HR 2.20, 95% CI 1.36 to 3.63), left main culprit artery (HR 4.46, 95% CI 1.64 to 10.25), and shock (HR 7.44, 95% CI 4.56 to 12.31), but multivessel disease with CTO was not a predictor. In contrast, multivessel disease with CTO was an independent predictor of mortality in patients without CKD (HR 3.30, 95% CI 1.70 to 6.17). In conclusion, in patients with STEMIs who underwent primary PCI, with preexisting CKD, the prevalence of CTO in a non-infarct-related artery was twice as great. In these patients, the clinical impact of CTO seems to be overshadowed by the presence of CKD.
authors.affiliation: Quebec Heart-Lung Institute, Department of Cardiology, Quebec, Quebec, Canada.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Bataille
authors.forename: Guillaume
authors.initials: G
authors.lastname: Plourde
authors.forename: Jimmy
authors.initials: J
authors.lastname: Machaalany
authors.forename: Eltigani
authors.initials: E
authors.lastname: Abdelaal
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: Ugo
authors.initials: U
authors.lastname: Déry
authors.forename: Bernard
authors.initials: B
authors.lastname: Noël
authors.forename: Gérald
authors.initials: G
authors.lastname: Barbeau
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
mesh_terms: D000368:Aged; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality