J Invasive Cardiol. 2026 Oct 14. doi: 10.25270/jic/26.00260. Online ahead of print.
ABSTRACT
OBJECTIVES: To compare characteristics and in-hospital outcomes of dialysis vs non-dialysis patients undergoing chronic total occlusion percutaneous coronary intervention (CTO PCI).
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
PMID:42873920 | DOI:10.25270/jic/26.00260