Impact of Chronic Kidney Disease on Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions: Insights From Houston Methodist Chronic Total Occlusion Registry

BACKGROUND: Chronic kidney disease (CKD) is prevalent in patients undergoing percutaneous coronary intervention for chronic total occlusion and is associated with worse outcomes due to impaired renal function. Understanding the outcomes and predictors of adverse events in this population is crucial. METHODS: A retrospective observational study was conducted on patients undergoing chronic total occlusion percutaneous coronary intervention at Houston Methodist DeBakey Heart and Vascular Center (2018–2023). Patients were categorized on the basis of kidney function: CKD (estimated glomerular filtration rate <60mL/min per 1.73m²) and non-CKD. The primary end point was procedural success. Secondary end points included 1-year all-cause death; clinically driven target-lesion revascularization at 1 year; target-lesion failure, defined as the composite of heart failure hospitalization, stroke, target-lesion revascularization, and myocardial infarction at 1 year; in-stent restenosis at 1 year, and in-hospital complications. RESULTS: A total of 492 patients were included, with 176 (35.8%) diagnosed with CKD. Patients with CKD were older and had a higher comorbidity burden. Patients with CKD had more complex disease, with higher rates of multivessel disease and graft vessel stenosis. Procedural success rates were high and similar between the groups (83.0% versus 83.4%). While 1-year all-cause death was comparable, patients with CKD exhibited higher rates of target lesion revascularization (hazard ratio, 2.41 [95% CI, 1.53–3.78]; P<0.001). Procedural complexity was not found as an independent predictor of death or target lesion revascularization. CONCLUSIONS: Although chronic total occlusion percutaneous coronary intervention is associated with higher postprocedural outcomes in patients with CKD, procedural success was comparable between the groups. Further studies are needed to refine postprocedural management strategies.