Can iodixAnol ReducE the incidence of adverse renal or cardiac events in chronic total occlusion interventions (CARE-CTO): a substudy of the PROGRESS-CTO registry.

Abstract

Objectives: The impact of contrast type in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains controversial. The authors sought to evaluate the impact of contrast medium selection on patients undergoing CTO PCI.

Methods: The authors examined the outcomes of patients who underwent CTO PCI using iso-osmolar (iodixanol) vs pooled low-osmolar contrast media (LOCM) using data from the PROGRESS-CTO registry.

Results: Iodixanol was used in 1007 (18.1%) of 5558 CTO PCIs. Compared with pooled LOCM, iodixanol-treated patients were more likely to be women, were older, and more likely to have diabetes, dyslipidemia, hypertension, history of heart failure, myocardial infarction, coronary artery bypass graft surgery, and stroke. Iodixanol cases had higher complexity, with longer lesion length (35.25 ± 25.16 vs 28.91 ± 19.46 mm, P less than .001), higher prevalence of moderate or severe calcification (43% vs 37%, P less than .001) and moderate or severe proximal tortuosity (30% vs 24%, P less than .001), and higher Japanese-CTO (2.52 vs 2.17, P less than .001) and PROGRESS-CTO scores (1.30 vs 1.16, P less than .001). Iodixanol cases required longer procedure times but similar contrast volumes. Technical (85.3% vs 89.2%, P = .001) and procedural success (83.4% vs 87.3%, P = .001) were lower in iodixanol cases. Acute kidney injury (AKI) occurred in 6.4% of cases. After propensity score matching, the patients who received iodixanol had lower incidence of AKI (odds ratio [OR]: 0.67; 95% CI, 0.47, 0.97; P = .032) and a trend for lower incidence of major adverse renal or cardiovascular events (OR: 0.75; 95% CI, 0.56, 1.0; P = .061).

Conclusions: AKI occurred in approximately 6% of CTO PCI cases. Iodixanol use was associated with a lower incidence of AKI, despite being used in more complex patients.