ClinicalEffects of staged versus ad hoc percutaneous coronary interventions on renal function-Is there a benefit to staging?

- Staged PCI exposes patients to higher cumulative contrast and radiation dose.
- Staged PCI is associated with higher decline in renal function if initial GFR is ≤60 cm3/min.
- Staged PCI patients have higher SYNTAX scores and receive more stents than ad hoc.

AimThe purpose of this study is to determine whether ad hoc (same session) percutaneous coronary intervention, and staged (multiple session) percutaneous coronary intervention (PCI) have different renal outcomes.Methods and ResultsThis is a retrospective cohort study that compares the maximal decline in glomerular filtration rate (GFR) at various times points (3-6 days, 1-4 weeks, 4-12 weeks) after either ad hoc or staged PCI. 115 patients undergoing staged PCI and 115 matched ad hoc PCI controls were included in the study. They were equivalent in baseline GFR, left ventricular ejection fraction and intra-procedural volume status based on LVEDP. The group undergoing staged PCI had greater cumulative fluoroscopy time, SYNTAX score and number of stents placed. Staged PCIs used less contrast per catheterization (155.0 ± 5.6 mL) but higher cumulative contrast dose (326.6 ± 14.0 mL) compared to ad hoc PCIs (193.4 ± 7.2 mL). Following intervention, there was a progressive decline in renal function that did not significantly differ between the ad hoc and staged groups. In the subgroup of patients with initial GFR ≤60 cm3/min, staged PCI was associated with 2.6-fold greater decline in renal function 4-12 weeks after the procedure compared to ad hoc. A propensity match analysis performed in patients with GFR ≤60 cm3/min confirmed worse renal function in the staged group at 4-12 weeks.ConclusionsStaged PCI exposes patients to greater cumulative contrast agent loads. The decline in renal function observed in both groups did not differ significantly, however worse renal outcomes were observed in the staged PCI group with baseline GFR ≤60 cm3/min.