Long-term outcome of biopsy-proven cholesterol crystal embolism

Toriu, Naoya; Sumida, Keiichi; Mizuno, Hiroki; Hasegawa, Eiko; Suwabe, Tatsuya; Kawada, Manabu; Ueno, Toshiharu; Hayami, Noriko; Sekine, Akinari; Hiramatsu, Rikako; Yamanouchi, Masayuki; Hoshino, Junichi; Sawa, Naoki; Takaichi, Kenmei; Ohashi, Kenichi; Fujii, Takeshi; Ubara, Yoshifumi

doi:10.1007/s10157-019-01749-y

Cited by 3 publications

(6 citation statements)

References 13 publications

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“…The rate of the requirement for chronic hemodialysis within 1 year after PCI was 10.7% in patients with CCE, which was similar to that in a previous report. 6 Thirty-day, 1-year, and 5year mortality rates were 3.4%, 10%, and 28%, respectively for CCE complicated PCI patients, and the early mortality rate was similarly poor to that in a previous study reported as 16% for in-hospital mortality. 5 .…”

Section: Article In Pressmentioning

confidence: 47%

“…However, the definition of CCE was in line with actual clinical practice referred to in previous reports, and this study has a large study population and the advantage of being able to evaluate predictors and trends of CCE. 5,6 Advanced atherosclerosis and factors contributing to atherosclerosis, for example, ACS, cerebrovascular disease, aortic aneurysm, hypertension, and smoking are proposed as risk factors for CCE after interventional procedures. 5,10 Whereas some of them were also risk factors of CCE in this study population, interestingly, ACS was not.…”

Section: Discussionmentioning

confidence: 99%

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Incidence, Risk Factors, and Prognosis of Cholesterol Crystal Embolism Because of Percutaneous Coronary Intervention

Takahashi

Omuro

Ohya

et al. 2022

The American Journal of Cardiology

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Cholesterol crystal embolism (CCE) is a rare but serious complication of percutaneous coronary intervention (PCI). However, its incidence, risk factors, and prognosis in the contemporary era are not well known. We included 23,184 patients who underwent PCI in our institution between January 2000 and December 2019 in this study. The diagnosis of CCE was made histologically or by the combination of cutaneous signs and specific blood test results. In patients with CCE, we evaluated the incidence, risk factors, and prognosis. A total of 88 patients (0.38%) were diagnosed with CCE. The incidence of CCE seemed to decline through the investigated 20 years. Positive predictors of CCE were age ≥70 years (68% vs 59%, p = 0.012), aortic aneurysm (23% vs 7.2% p <0.001), and a femoral approach (71% vs 45%, p <0.001), whereas a negative predictor of CCE was the use of an inner sheath (63% vs 77%, p <0.001). The rate of 1-year mortality and the requirement for chronic hemodialysis within 1 year after PCI in patients with CCE were 10% and 11%, respectively. The use of an inner sheath and a nonfemoral approach was associated with a lower incidence of CCE. In conclusion, because the prognosis of patients with CCE is still poor, preprocedural identification of high-risk patients and selection of low-risk procedures could be important for preventing CCE.

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Section: Article In Pressmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Prognosis of Cholesterol Crystal Embolism Because of Percutaneous Coronary Intervention

Takahashi

Omuro

Ohya

et al. 2022

The American Journal of Cardiology

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“…Kidney and overall prognoses are variable but historically poor with a dialysis dependence rate of 28%-60% with 20%-30% partial recovery and a 1-year mortality rate of 64%-81% in older studies (2,5). Management is limited to supportive care including BP control, withdrawal of anticoagulation, and optimizing nutrition (2,5). Statins seem to offer improved kidney and overall survival benefit through plaque stabilization (2).…”

Section: Discussionmentioning

confidence: 99%

“…Kidney injury can take an acute (<1 week), subacute (1–6 weeks, most common), or a smoldering chronic progressive course (5). Kidney and overall prognoses are variable but historically poor with a dialysis dependence rate of 28%–60% with 20%–30% partial recovery and a 1-year mortality rate of 64%–81% in older studies (2,5). Management is limited to supportive care including BP control, withdrawal of anticoagulation, and optimizing nutrition (2,5).…”

Section: Discussionmentioning

confidence: 99%

Eosinophilia and Skin Rash in a Patient with Uncontrolled Hypertension and AKI

Aklilu

2021

Kidney360

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“…Cholesterol embolization syndrome (CES) is an uncommon cause of renal failure. [1][2][3] Occlusion of renal arteries, arterioles, and glomeruli by cholesterol crystals leads to irreversible ischemic damage and loss of kidney function. CES carries a poor prognosis.…”

Section: Introductionmentioning

confidence: 99%