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

Aim The 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 Results This 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. Conclusions Staged 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.