D-46 | IVUS-Guided Ultralow-Contrast PCI in Patients with CKD and Reduced Ejection Fraction: Safety Outcomes Analysis

CKD and HFrEF are both significant risk factors for contrast-induced nephropathy (CIN), need for renal replacement therapy (RRT), and MACE after PCI. As a result, IVUS-guided ultralow-contrast (ULC) PCI has been developed. Unfortunately, in the few studies that examine ULC PCI, there is no data examining the safety and outcomes of patients with CKD and HFrEF. Consequently, we aimed to compare PCI outcomes in patients with CKD and HFrEF versus patients with CKD and normal EF undergoing ULC PCI. We performed a retrospective analysis of patients receiving ULC (<30mL) PCI at a single institution from 2016-2022. Inclusion criteria included patients with CKD stages 3b-5 (eGFR <45 mL/min/1.73m2), not on RRT. We risk-stratified patients based on baseline ejection fraction: EF < 40% (termed the high-risk group) compared with EF >40% (termed the low-risk group). Primary outcomes included change in eGFR before and after PCI; and rates of death, MACE, and requirement for RRT. 100 patients were included: 40 within the high-risk group and 60 within the low-risk group; baseline eGFR in the high-risk group was 24.9 mL/min/1.73m2 vs 22.3 mL/min/1.73m2 in the low-risk group (p=0.24); EF in the high-risk group was 30% vs 57% in the low-risk group (p=0.01). Mean contrast load was 8.9mL in the high-risk group and 9.2mL in the low-risk group (p=0.86). Mean change in eGFR for the high-risk group post-PCI (0.45 ± 3.78 mL/min/1.73m2) was not significantly different than the low-risk group (-0.69 ± 4.98 mL/min/1.73m2), p=0.31. At one year, the high-risk group had 5 deaths (12.5%) vs the low-risk group having 3 (7.25%), p=0.18. The incidence of RRT requirement was numerically higher in the high-risk group (17.5% vs 8.3%, p=0.17), and MACE occurred in 32.5% of high-risk patients vs 23.3% of low-risk patients (p=0.32). In the high-risk group, there was no statistically significant change in eGFR or increased RRT requirement suggestive of limited additional procedure-related renal risk after undergoing ULC PCI. These findings, in conjunction with similar rates of MACE, demonstrate for the first time that ULC PCI is feasible in patients with severely impaired eGFR and reduced EF.