IVUS-guided, contrast-free PCI is safe and feasible in patients with chronic kidney disease (CKD) and may improve acute and long-term renal and cardiovascular outcomes, as reported by Dr. Keita Shibata of Showa University Koto-Toyosu Hospital and his colleagues in the May issue of Circulation Journal.
The Efficacy, Safety, and Long-Term Outcomes of Zero-Contrast PCI in Patients with Chronic Kidney Disease
The study retrospectively evaluated the feasibility and safety of zero contrast PCI by collecting data on patient background, technique, and acute and long-term clinical outcomes in a single-center PCI registry.
A total of 698 consecutive patients (1,061 procedures) who underwent PCI were included in the evaluation. Patients with acute coronary syndromes, patients on maintenance hemodialysis, and patients scheduled for PCI with rotablator were excluded. Finally, patients were divided into two groups: zero contrast PCI (55 patients, 78 procedures) and conventional PCI (462 patients, 670 procedures).
After propensity score matching, 50 patients in each group were matched to evaluate long-term outcomes. All patients in the zero contrast PCI group had stage 3-5 CKD with an estimated glomerular filtration rate of 38.3 ± 14.8 mL/min/1.73 m2.
All 78 patients underwent successful zero contrast PCI with no renal events such as acute kidney injury or emergency hemodialysis, and no procedural complications such as coronary perforation or perioperative MI. Of the 78 patients, 7 died (1 cardiac, 6 non-cardiovascular) and 4 underwent renal replacement therapy during the 32-month follow-up period. The incidence of MACE was similar in the no contrast group and the conventional PCI group (log-rank: p=0.95).
Dr. Shibata et al. summarized, “In this study, PCI with zero contrast was successful in all CKD patients without procedural complications; the incidence of MACE was similar in CKD patients undergoing PCI with zero contrast and non-CKD patients undergoing conventional PCI. No renal events occurred during hospitalization, and the incidence of renal replacement therapy after zero contrast PCI was low, suggesting that zero contrast PCI is beneficial to renal function and clinical outcomes.”
Shibata K, et al. Circ J. 2022; 86: 787-796
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