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Ultra-Low Contrast versus Conventional Percutaneous Coronary Intervention for Patients with Baseline Renal
Marcos Danillo Oliveira1, Ricardo Fonseca Oliveira Suruagy-Motta2, Leonardo Dexheimer da Silva3
1Departamento de Cardiologia Intervencionista, Universidade Federal de São Paulo, São Paulo, SP - Brasil.
Insights
Ultra-low contrast (ULC) percutaneous coronary intervention (PCI) significantly reduces contrast-associated acute kidney injury (CA-AKI) in patients with chronic kidney disease. While safe and feasible, further trials are needed to confirm effects on dialysis, mortality, and MACE.
Area of Science:
- Nephrology
- Cardiology
- Interventional Cardiology
- Radiology
Background:
- Contrast-associated acute kidney injury (CA-AKI) significantly increases patient morbidity, mortality, and healthcare costs.
- Limiting contrast volume (CV) and utilizing ultra-low contrast (ULC) volume coronary procedures (total CV ≤ estimated glomerular filtration rate [eGFR]) are associated with reduced CA-AKI risk.
Purpose of the Study:
- To conduct a systematic review and meta-analysis comparing clinical outcomes of ULC versus conventional percutaneous coronary intervention (PCI) in patients with chronic kidney disease.
Main Methods:
- Comprehensive literature search across major databases (PubMed/MEDLINE, Cochrane, Embase, Scopus, Web of Science).
- Inclusion of studies reporting clinical outcomes of ULC PCI.
- Primary endpoint: incidence of CA-AKI. Secondary endpoints: need for dialysis, all-cause mortality, and major adverse cardiovascular events (MACE).
Main Results:
- Analysis of six studies involving 274,102 patients.
- ULC PCI demonstrated a statistically significant reduction in CA-AKI incidence (risk ratio=0.27; p=0.0004).
- No statistically significant reductions were observed for need for dialysis (p=0.186), all-cause mortality (p=0.18), or MACE (p=0.16).
Conclusions:
- ULC PCI is safe and feasible compared to conventional PCI in patients with chronic kidney disease.
- ULC PCI is associated with a significant reduction in CA-AKI.
- Larger, well-powered randomized controlled trials are necessary to confirm these findings and assess other clinical outcomes.
Background:
Contrast-associated acute kidney injury (CA-AKI) results in increased morbidity and mortality, prolonged hospitalization, and worse clinical outcomes. Prior studies have shown that limiting contrast volume (CV) to less than 3 times the estimated glomerular filtration rate (eGFR) implies a lower risk of CA-AKI, and both efficacy and superior outcomes are associated with ultra-low contrast (ULC) volume coronary procedures (total CV ≤ eGFR).
Objectives:
This systematic review and meta-analysis aimed to compare clinical outcomes of ULC versus conventional percutaneous coronary intervention (PCI) in patients with chronic kidney disease.
Methods:
The search was conducted in the databases PubMed/MEDLINE, Cochrane, Embase, Scopus, and Web of Science, including all studies reporting clinical outcomes of ULC PCI. The primary efficacy endpoint was the incidence of CA-AKI, and secondary endpoints were need for dialysis, all-cause mortality, and major adverse cardiovascular events (MACE), defined as the composite endpoint of all-cause mortality, non-fatal myocardial infarction, and clinically driven target lesion revascularization.
Results:
Six studies met the inclusion criteria and were included in the final analysis, encompassing a total of 274,102 patients. ULC PCI was associated with a statistically significant reduction of CA-AKI (risk ratio=0.27; 95% CI=0.13-0.56; p=0.0004). In turn, ULC PCI did not result in statistically significant reduction of need for dialysis (risk ratio=0.33; 95% CI=0.06-1.72; p=0.186), all-cause mortality (risk ratio=0.48; 95% CI=0.17-1.39; p=0.18), and MACE (risk ratio=0.52; 95% CI= 0.21-1.30; p=0.16).
Conclusions:
ULC, as compared to conventional PCI, in patients with chronic kidney disease, was found to be safe, feasible, and associated with a statistically significant reduction of CA-AKI. Further, larger, well-powered, randomized, and controlled trials are warranted in order to reassure these findings.
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