Abstract
This study aims to elucidate 1-year clinical outcomes using this technique for patients with stage 4 or 5 advanced chronic kidney disease (CKD). Research has proven that imaging-guided percutaneous coronary intervention (PCI) reduces contrast volume significantly; however, only short-term clinical benefits have been reported. Minimum-contrast (MINICON) studies are based on the registry design pattern to enroll PCI results in patients with advanced CKD stage 4 or 5 comorbid with coronary artery disease. We excluded cases of emergency PCI or maintenance dialysis from this study. In this study, we compared the intravascular ultrasound (IVUS)-guided MINICON PCI group (n = 98) with the angiography-guided standard PCI group (n = 86). Enrollment of the MINICON studies started in 2006. Before 2012, IVUS-guided MINICON PCI was performed only in 14% (stage 1), but it was 100% after 2012 (stage 2). The enrollment finished in 2016. The IVUS-guided MINICON PCI group exhibited a significantly reduced contrast volume (22 ± 20 vs. 130 ± 105 mL; P < 0.0001) and contrast-induced acute kidney injury (CI-AKI; 2% vs. 15%; P = 0.001). The PCI success rate was similarly high (100% vs. 99%; P = 0.35). At 1 year (follow-up rate, 100%), we observed less induction of renal replacement therapy (RRT; 2.7% vs. 13.6%; P = 0.01), but all-cause mortality or myocardial infarction was similar in both groups. The IVUS-guided MINICON PCI reduces CI-AKI significantly and induction of RRT at 1 year in patients with stage 4 or 5 advanced CKD.
Similar content being viewed by others
References
McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008;51:1419–28.
Giacoppo D, Madhavan MV, Baber U, Warren J, Bansilal S, Witzenbichler B, et al. Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes: pooled analysis from the HORIZONS-AMI and ACUITY trials. Circ Cardiovasc Interv. 2015;8:e002475.
Brar SS, Aharonian V, Mansukhani P, Moore N, Shen AY, Jorgensen M, et al. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomized controlled trial. Lancet. 2014;383:1814–23.
Stacul F, Adam A, Becker CR, Davidson C, Lameire N, McCullough PA, et al. Strategies to reduce the risk of contrast-induced nephropathy. Am J Cardiol. 2006;98:59K–77K.
Giacoppo D, Gargiulo G, Buccheri S, Aruta P, Byrne RA, Cassese S, et al. Preventive strategies for contrast-induced acute kidney injury in patients undergoing percutaneous coronary procedures: evidence from a hierarchical Bayesian network meta-analysis of 124 trials and 28 240 patients. Circ Cardiovasc Interv. 2017;10:e004383.
Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44:1393–9.
Nyman U, Bjork J, Aspelin P, Marenzi G. Contrast medium dose-to-GFR ratio: a measure of systemic exposure to predict contrast-induced nephropathy after percutaneous coronary intervention. Acta Radiol. 2008;49:658–67.
Ali ZA, Karimi Galougahi K, Nazif T, Maehara A, Hardy MA, Cohen DJ, et al. Imaging- and physiology-guided percutaneous coronary intervention without contrast administration in advanced renal failure: a feasibility, safety, and outcome study. Eur Heart J. 2016;37:3090–5.
Ogata N, Matsukage T, Toda E, Tamiya S, Fujii T, Nakazawa G, et al. Intravascular ultrasound-guided percutaneous coronary interventions with minimum contrast volume for prevention of the radiocontrast-induced nephropathy: report of two cases. Cardiovasc Interv Ther. 2011;26:83–8.
Ogata N, Ikari Y, Nanasato M, Okutsu M, Kametani R, Abe M, et al. Safety margin of minimized contrast volume during percutaneous coronary intervention in patients with chronic kidney disease. Cardiovasc Interv Ther. 2014;29:209–15.
Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revized equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.
KDIGO. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2012;2013(3):1–150.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.
Reddan DN, Szczech LA, Tuttle RH, Shaw LK, Jones RH, Schwab SJ, et al. Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol. 2003;14:2373–80.
Hemmelgarn BR, Southern D, Culleton BF, Mitchell LB, Knudtson ML, Ghali WA, et al. Survival after coronary revascularization among patients with kidney disease. Circulation. 2004;110:1890–5.
Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv. 2014;7:1–9.
Dangas G, Iakovou I, Nikolsky E, Aymong ED, Mintz GS, Kipshidze NN, et al. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol. 2005;95:13–9.
Gurm HS, Dixon SR, Smith DE, Share D, Lalonde T, Greenbaum A, et al. Renal function-based contrast dosing to define safe limits of radiographic contrast media in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol. 2011;58:907–14.
Acknowledgements
We thank Ms. Eri Tomita, Ms. Fumie Saito and Ms. Mineko Naganawa for their clerical assistance. MINICON study group: Principal investigators: Yuji Ikari, MD, PhD (Tokai University School of Medicine, Isehara Japan). MINICON study investigators: Mamoru Nanasato, MD, Yasuko Kato (Cardiovascular Center, Nagoya Daini Red Cross Hospital, Japan), Hiroshi Umetsu, MD (Seirei Fuji Hospital, Japan), Katsuaki Sakai, MD, Yuji Ikari, MD, PhD, (Tokai University School of Medicine, Isehara, Japan), Masaaki Okutsu, MD, Takashi Kitao, MD (Nozaki Tokushukai hospital, Japan), Tomonobu Takikawa, MD, Takuya Sumi, MD (Kasugai Municipal Hospital, Japan), Satoru Sumitsuji, MD, Kensuke Yokoi, MD (Osaka University Graduate School of Medicine, Japan), Kenji Sadamatsu, MD, Yasuaki Koga, MD (Saga-ken Medical Centre Koseikan, Japan), Masanori Takada, MD (Medical corporation Kawasaki hospital, Japan), Nobuyuki Ogasawara, MD, Shinji Hasegawa, MD, (Japan Community Healthcare Organization Osaka Hospital, Japan), Kanichi Otowa, MD (Municipal Tsuruga Hospital, Japan), Hiroshi Asano MD, PhD (National Hospital Organization Kyoto Medical Center, Japan), Mitsuru Abe, MD (National Hospital Organization Kyoto Medical Center, Japan), Kohei Wakabayashi, MD, Masahiro Sasai, MD (Showa University Fujigaoka Hospital, Japan).
Funding
Daiichi Sankyo Company, Limited (Tokyo, Japan).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sakai, K., Ikari, Y., Nanasato, M. et al. Impact of intravascular ultrasound-guided minimum-contrast coronary intervention on 1-year clinical outcomes in patients with stage 4 or 5 advanced chronic kidney disease. Cardiovasc Interv and Ther 34, 234–241 (2019). https://doi.org/10.1007/s12928-018-0552-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12928-018-0552-7