{
  "abstract": "Introduction Limited data exists regarding the incidence of contrast-induced nephropathy (CIN) following ultra-low contrast percutaneous coronary intervention (ULCPCI). For patients with chronic kidney disease (CKD), both coronary angiography and Percutaneous Coronary Intervention (PCI) carry an elevated risk of developing contrast-induced nephropathy (CIN) and subsequently requiring renal replacement therapy (RRT). The incidence of CIN ranges from 2% to 30%, and this can be as high as 20-30% in high-risk groups with risk factors for kidney disease. CIN is defined as impairment of renal function measured as either a 20% rise in serum creatinine from baseline or an increase of 44 µmol/L within 48-72 hours following IV contrast administration. Ultra-low contrast PCI is defined as a ratio of volume of contrast administered to estimated glomerular filtration rate (eGFR) <1 or contrast use of <30 mLs in other studies. The purpose of this study is to contribute single-center data on the outcomes following ultra-low contrast percutaneous coronary intervention (ULCPCI).We aimed to evaluate our single center experience of ultra-low contrast PCI (ULPCI) and to characterize 6 month outcomes in patients with advanced chronic kidney disease (CKD) who were not on renal replacement therapy at baseline in Ipswich Hospital, United Kingdom, from January 2023 to January 2020. Specifically, we aimed to evaluate the safety and renal outcomes by assessing the incidence of changes in renal function following ULPCI at 6 months and the frequency of adverse events such as the need for RRT, stroke, MACE (Major Adverse Cardiac Events) and mortality, occurring within or at 6 months post-procedure.Methods A retrospective analysis was conducted at our institution to evaluate outcomes of ultra-low contrast percutaneous coronary intervention (PCI). The study considered 17 patients with CKD stage 3b-5 (eGFR <45 mL/min/1.73m2) who underwent PCI using less than 30 mL of contrast between January 2023 and January 2020. Patients already receiving renal replacement therapy (RRT) were excluded (n=4). Both elective (n=5) and acute coronary syndrome (NSTEMI) (n=9) indications were present (see figure 1).All included patients underwent an intervention, which encompassed PCI procedures on the Left Anterior Descending (LAD) artery, Left Main Stem (LMS), Obtuse Marginal (OM) branches, and Right Coronary Artery (RCA), as well as pressure wire studies (See table 1).The primary outcomes assessed were the post-procedural change in eGFR and the incidence of death, RRT requirement, and major adverse cardiac events (MACE) at 6-month follow-up. Paired t-test analysis was used for statistical evaluation.Results ULCPCI was performed in 14 patients with advanced CKD, none of whom were on RRT at baseline. The median age was 79 years old (IQR 69-82) and 43% were female. The median baseline eGFR was 27 mL/min/1.73m2 (IQR 19-34). A median of 9.0 mL (IQR 6-15) of contrast was used during PCI. Median contrast use to eGFR ratio was 0.34 (IQR 0.21-0.59). There were no patients who required RRT within 1 month after PCI. There was no significant difference between pre-and postprocedure eGFR (p = 0.177). At 6 months, 7.14% (n=1) of patients died, 21.4% (n=3) required RRT and 21.4% (n=3) experienced MACE (See table 2).Conclusions This study supports that ultra-low contrast Percutaneous Coronary Intervention (PCI) is a safe and viable option for patients with advanced Chronic Kidney Disease (CKD). It reduces the requirement of peri-procedural Renal Replacement Therapy (RRT). The paired t-test demonstrated no statistically significant difference between baseline and 6-month eGFR (p = 0.177). These outcomes suggest that ULCPCI in elderly, high-risk CKD patients (not on RRT) allows for successful intervention with low contrast, limiting acute contrast nephropathy, but significant long-term risks (stroke, need for RRT, and death) remain high due to underlying disease severity and frailty.The limitation of this study is a small sample size. In addition, the high prevalence of multiple comorbidities among participants introduces potential confounding variables, complicating the assessment of a causal link between ultra-low contrast PCI (ULCPCI) and the primary outcomes.Abstract 182 Figure 1Patient selection criteria for Ultra-Low Contrast PCI StudyAbstract 182 Table 1Interventional procedures performedInterventionNo. of CasesPCI to LMS–LAD2PCI to LAD7PCI to LAD & OM11PCI to RCA3Pressure wire to RCA1Note: PCI = percutaneous coronary intervention; LMS = left main stem; LAD = left anterior descending artery; OM1 = first obtuse marginal branch; RCA = right coronary artery.Abstract 182 Table 2Six-month clinical outcomes after ultra-low contrast PCIClinical Outcomen%Death17.14Required initiation of RRT post-PCI321.4Developed MACE (including Death)321.4Stroke3—Myocardial Infarction (MI)0—Death1—",
  "authors": [
    {
      "affiliations": [
        "Ipswich Hospital, Ipswich, United Kingdom"
      ],
      "name": "Zafar Ullah"
    },
    {
      "affiliations": [
        "Ipswich Hospital, Ipswich, United Kingdom"
      ],
      "name": "Karl Buerano"
    }
  ],
  "title": "182 A single-centre study on clinical outcomes of ultra-low contrast percutaneous coronary intervention in patients with advanced chronic kidney disease",
  "uid": "4b5a13cb-7737-5a18-ba09-a5225c3766ad"
}