Chronic total occlusion percutaneous coronary interventions in dialysis patients

To compare characteristics and in-hospital outcomes of dialysis vs non-dialysis patients undergoing chronic total occlusion percutaneous coronary intervention (CTO PCI).

The authors analyzed 18 572 patients undergoing CTO PCI between 2012 and 2026. Outcomes were compared using multivariable logistic regression and propensity score-matching weights. Mortality was evaluated by cumulative center-enrollment category.

Overall, 447 patients (2.4%) were receiving dialysis. Compared with non-dialysis patients, they more often had diabetes mellitus (70.5% vs 43.1%), hypertension (93.5% vs 87.1%), heart failure (52.7% vs 27.0%), cerebrovascular disease (17.9% vs 9.1%), peripheral arterial disease (29.1% vs 12.7%), and moderately or severely calcified CTOs (68.2% vs 47.0%; all P < .001). Technical success (85.2% vs 87.4%; P = .190) and procedural success (83.9% vs 86.2%, P = .192) were similar. Retrograde approach (31.1% vs 31.3%; P = .90) and antegrade dissection re-entry (21.3% vs 19.8%; P = .40) were used similarly. In-hospital major adverse cardiac events (MACE) did not differ (2.9% vs 1.9%; P = .11), whereas in-hospital mortality was higher (1.8% vs 0.5%; P = .001) in dialysis patients. The mortality odds ratio (OR) was 2.36 (95% confidence interval [CI], 0.70-5.90; P = .106) in multivariable analysis and 2.42 (95% CI, 1.13-5.16; P = .022) after propensity score weighting. The dialysis-mortality association did not vary across center-enrollment categories (interaction P = .522).

Despite greater clinical and angiographic complexity, dialysis patients had no significant differences in procedural success or MACE but had higher in-hospital mortality. The mortality association remained imprecise, and residual confounding cannot be excluded.