Author + information
- Ziad Ali1,
- Keyvan Karimi Galougahi2,
- Tamim Nazif1,
- Akiko Maehara3,
- David Cohen1,
- Mark Hardy4,
- Lloyd Ratner1,
- Michael Collins1,
- Jeffrey Moses1,
- Ajay Kirtane1,
- Gary Mintz3,
- Gregg Stone5,
- Dimitri Karmpaliotis1 and
- Martin Leon1
- 1NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 2New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 3Cardiovascular Research Foundation, New York, New York, United States
- 4NewYork-Presbyterian Hospital/Columbia University Medical Center, New Yrok, New York, United States
- 5Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Percutaneous coronary intervention (PCI) in patients with advanced chronic kidney disease (CKD) is associated with high risk of contrast-induced nephropathy and need for renal replacement therapy (RRT). We investigated a strategy for “zero contrast” PCI with the aims of preserving renal function and preventing need for RRT in patients with advanced CKD.
Zero contrast PCI was performed >1 week after ultra-low contrast angiography (ULCA, contrast volume (CV)/eGFR<1). Previous angiogram was used as guide and multiple guidewires placed to create a metallic silhouette of the coronary anatomy as the road map for PCI. PCI was performed with intravascular ultrasound (IVUS) guidance and pre and post PCI fractional flow reserve (FFR) and coronary flow reserve (CFR) measurements to confirm physiological improvement.
31 patients with advanced CKD (creatinine=4.2mg/dL(IQR:3.1-4.8), eGFR= 16±8ml/min/1.73m2) with a clinical indication for angiography for stable coronary disease were included. ULCA was performed (CV=13ml, IQR:12-15) with the CV/eGFR<1 achieved in all cases. Renal function post angiography (21 hours IQR:9-36) remained stable (creatinine=3.9, IQR:2.9-4.9; eGFR=18±8, p>0.05). At staged PCI, physiological significance of lesions was documented (FFR=0.74, IQR:0.70-0.77, CFR=1.4, IQR:1.1-1.9). 42% of lesions were AHA class B2 or C and most patients received a single stent. Post-PCI minimal stent area was 6.8mm2 (IQR:5.9-8.3) with pre-determined target (>90% of mean of proximal and distal reference area) achieved in 87%, leading to physiological improvement in all cases (FFR=0.92 IQR:0.90-0.93, CFR=2.6 IQR:2.3-4.2, p<0.001). No contrast was used in any of the patients. At follow-up (79 days, IQR:33-207), neither creatinine (3.7, IQR 3.0-4.5; p=0.69) nor eGFR (18, IQR:14-22 p=0.70) changed and no patient required RRT. Lastly, there were no major adverse cardiac events (stent thrombosis, MI, repeat revascularization, or death).
To our knowledge this is the first reported series of zero contrast PCI. In patients with advanced CKD who need revascularization, PCI may safely be performed without contrast with high procedural success.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)