Author + information
- Vishal Patel,
- Tesfaldet Michael,
- Owen Mogabgab,
- Eric Fuh,
- Nathan Lo,
- Shuaib Abdullah,
- Subhash Banerjee and
- Emmanouil Brilakis
Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can provide significant clinical benefit: however procedural risks have been poorly studied. Identifying predictors of high periprocedural risk may guide patient and lesion selection to minimize this risk.
The clinical, angiographic, and procedural records of 336 consecutive CTO PCI procedures were reviewed for procedural complications.
The incidence of major and minor complications was 3.9% and 10.4%, respectively. Minor bleeding and vascular events were the most common complication (4.8%) followed by perforation (2.4%), contrast induced nephropathy (1.8%), and transient hypotension (0.6%). Major complications were uncommon: death (0.3%), emergency coronary artery bypass grafting (0.6%), stroke (0.3%), tamponade (0.3%), clinical myocardial infarction (0.9%), donor vessel injury (0.6%), and major bleeding or vascular events (0.9%). Patients who experienced a complication had higher pre–procedure troponin levels and were more likely to undergo treatment using the retrograde procedure (Table). In multivariable analysis use of the retrograde approach was independently associated with periprocedural complications (odds ratio 2.1, p=0.03).
Major complications are infrequent during CTO PCI. Use of the retrograde approach was associated with a higher risk of periprocedural complications.
Clinical, Angiographic, and Procedural Characteristics of Patients Undergoing CTO PCI
|Demographics||No Complications (n = 291)||Any Complication (n = 45)||p value|
|Age||63.8 +/− 8.3||62.5 +/− 8.6||0.3113|
|Prior myocardial infarction||47.1||44.4||0.7417|
|Ejection fraction (%)||46.3||45.3||0.6288|
|Prior coronary artery bypass graft surgery||25.1||29.6||0.5296|
|Non-acute coronary syndrome||80.4||75.6||0.4505|
|Acute coronary syndrome||19.6||24.4|
|Pre-Cath Creatine kinase-MB||3.2 +/− 3.1||3.9 +/− 4.8||0.1811|
|Pre-Cath Troponin xUpper Limit Normal||14.1||64.0||0.0133|
|Left anterior descending||20.1||23.3||0.9347|
|Right coronary artery Graft||0.8||0.0|
|Contrast Volume (mL)||351.7 +/− 138.1||394.2 +/− 132.5||0.0602|
|Fluoroscopy Time (min)||38.2 +/− 21.4||45.7 +/− 23.8||0.0373|
|Radiation dose area product (Gray cm⁁2)||327483||392849||0.0382|
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Chronic Total Occlusions
Abstract Category: 44. TCT@ACC–i2: Coronary Intervention, CTO
Presentation Number: 2103–242
- 2013 American College of Cardiology Foundation