Revascularization of coronary chronic total occlusion in patients with end stage renal disease

Chronic total occlusion (CTO) was frequently observed during coronary angiography. Successful revascularization of chronic total occlusion showed controversial result on long-term survival in previous studies. There is scarce report about long-term outcome of successful recanalization of CTO in patients with end stage renal disease (ESRD) receiving renal replacement therapy. This is a retrospective study conducted in two tertiary medical centers (Taipei and Taichung Veterans General hospitals) in Taiwan. From January 2005 to December 2016, a total of 47,784 patients received coronary angiography in these centers. Among them, 216 patients with ESRD who were found to have CTO lesions during coronary angiography received revascularization. Revascularization was succeeded in 163 patients (75%). Patients were followed up for three years. Successful revascularization was associated with lesser major adverse cardiovascular event (MACE) at 3 year (hazard ratio (HR) 0.518, 95% confidence interval (CI) 0.332-0.810, p = 0.004), better survival at 3 years (HR 0.502, 95% CI 0.314-0.800, p = 0.004) and improved cardiovascular death (HR 0.449, 95% CI 0.223-0.902, p = 0.025). In multivariate analysis, successful revascularization remained independent predictor of three-years MACE (HR 0.588, 95% CI 0.369-0.939, p = 0.026) irrespective of age, gender, serum hemoglobin level, co-morbidities such as peripheral arterial disease and diabetes mellitus and medications such as beta blocker and statin. In patients on renal replacement therapy, successful recanalization of chronic total occlusion reduced MACE at 3 years compared to those failed.