Percutaneous Coronary Intervention Outcomes for Chronic Total Occlusion in Patients on Dialysis: Analysis of the Japanese CTO-PCI Expert Registry

Background: Patients undergoing dialysis are at a high risk of cardiovascular death, and the prevalence of coronary complex lesions is high. Aims: This study aimed to analyze the characteristics, outcomes, and adverse events of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) in patients undergoing dialysis. Methods: We examined 11,664 patients enrolled in the Japanese CTO-PCI Expert Registry between January 2014 and December 2022. Results: Dialysis was performed in 6.9% of all patients with CTO and was associated with a lower technical success rate than those who did not undergo dialysis (85.4% vs. 92.4%, p < 0.001). Dialysis was an independent predictor of technical failure (odds ratio, 1.510; 95% CI, 1.200-1.910; p < 0.001). Patients on dialysis had increased procedure times and puncture site complication rates; however, they did not show an increased incidence of major adverse cardiac or cerebrovascular events (MACCE) (1.6% vs. 1.8%, p = 0.890). PCI in patients on dialysis necessitated the high rate of debulking device use, even when calcification was not severe, and hard tip load wire selection for CTO crossing. In patients on dialysis, calcification, lesion tortuosity, and reattempts were associated with technical failure. Patients on dialysis without these predictors achieved a high technical success rate equivalent to that of patients not on dialysis. Conclusions: PCI in patients undergoing dialysis was associated with a low success rate but could be performed safely without increasing MACCE. Debulking devices may be required for calcification, and careful attention is required to prevent puncture site complications.