Revascularization of coronary chronic total occlusion in patients with end stage renal disease

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Chronic total occlusion (CTO) is common in patients undergoing coronary angiography.
• Previous studies show controversial long-term survival outcomes after CTO revascularization.
• Limited data exists on the long-term effects of successful CTO recanalization in end-stage renal disease (ESRD) patients on renal replacement therapy (RRT).

Purpose of the Study:

• To evaluate the long-term outcomes of successful CTO recanalization in ESRD patients receiving RRT.
• To assess the impact of successful CTO revascularization on major adverse cardiovascular events (MACE), survival, and cardiovascular death.

Main Methods:

• Retrospective study at two tertiary medical centers in Taiwan (January 2005 - December 2016).
• Included 216 ESRD patients with CTO lesions who underwent revascularization.
• Successful revascularization achieved in 163 patients (75%), with a three-year follow-up period.

Main Results:

• Successful revascularization was associated with significantly lower MACE at 3 years (HR 0.518, p=0.004).
• Better survival rates were observed at 3 years in the successful revascularization group (HR 0.502, p=0.004).
• Reduced cardiovascular death was noted (HR 0.449, p=0.025), with successful revascularization being an independent predictor of reduced 3-year MACE in multivariate analysis.

Conclusions:

• Successful recanalization of CTO in ESRD patients on RRT is associated with improved cardiovascular outcomes.
• This intervention significantly reduces MACE and cardiovascular mortality at three years.
• Successful CTO revascularization is an independent predictor of better long-term outcomes in this high-risk patient group.