Impact of renal function on the immediate and long-term outcomes of percutaneous recanalization of coronary chronic total occlusions: A systematic review and meta-analysis

Background: Renal impairment is associated with worse in-hospital and long-term outcomes after coronary artery revascularization, yet limited evidence is available on its impact on short- and long-term outcomes after chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We conducted a systematic review of the literature and subsequent random-effect meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement to evaluate the effect of chronic kidney disease (CKD), defined as estimated glomerular filtration rate < 60 ml/min/1.73 m², on CTO PCI. The outcomes of this study were in-hospital death, procedural failure, contrast-induced acute kidney injury and all-cause death at follow-up. Results: Eight studies, with a total of 8439 patients (of whom 2256 had CKD) were included in the analysis. CKD was associated with higher technical (relative risk [RR] = 1.44, 95% confidence interval [CI] 1.14–1.82, p =.002) and procedural (risk ratio-RR = 1.40, 95% CI 1.00–1.96, p =.05) failure, higher in-hospital mortality (RR = 4.96, 95% CI 2.49–9.87 p <.001), bleeding complications (RR = 3.43, 95% CI 1.80–6.52, p <.001) and contrast-induced acute kidney injury (RR = 2.75, 95% CI 1.16–6.51, p =.001). CKD was also associated with higher all-cause mortality during long-term follow-up (RR = 3.56, 95% CI 1.08–5.99, p <.001). Conclusion: Compared with patients with normal renal function, CKD is associated with lower success and higher risk of acute and long-term complications after CTO PCI. Kidney function should be considered during decision-making on CTO recanalization.