Author + information
- Sang Yeub Lee1,
- Nelson Bernardo2,
- Gallino Robert A3,
- Hector M. Garcia-Garcia4,
- Arie Steinvil5,
- Toby Rogers6,
- Sarkis Kiramijyan7,
- Edward Koifman8,
- Smita I. Negi9,
- Jiaxiang Gai10,
- Rebecca Torguson11,
- Lowell Satler11,
- Augusto Pichard11 and
- Ron Waksman12
- 1MedStar Washington Hospital Center, North Bethesda, Maryland, United States
- 2Medstar Heart Institute at Washington Hospital, Washington, District of Columbia, United States
- 3University of Missouri-Columbia, Columbia, Missouri, United States
- 4Medstar Washington Hospital, Washington, D.C., United States
- 5The Tel-Aviv Medical center, Tel-Aviv, Israel
- 6Complejo Hospitalario de Huelva, Huelva, Spainn
- 7Division of Cardiology, Department of Medicine and Clinical Scie
- 8MedStar Washington Hospital Center, Washington, District of Columbia, United States
- 9Toda Central General Hospital
- 10University of Verona, Verona, Italy
- 11Washington Hospital Center, Washington, District of Columbia, United States
- 12Medstar Heart Institute, Washington, District of Columbia, United States
New techniques and devices have been widely used in CTO intervention, but the impact of these contemporary approaches is not known. This study investigates the impact of contemporary approaches to recanalize chronic total occlusion (CTO) in the coronary bed.
The data were extracted from MedStar Washington Hospital Center prospectively generated catheterization laboratory registry. We reviewed a consecutive series of patients in whom PCI of CTO lesions were attempted from January 2003 to May 2016 (cohort 1: January 2003-september 2014; cohort 2: October 2014-May 2016). A CTO was defined as complete occlusion with TIMI grade 0 flow antegrade through affected segment of >3 months duration. Cohort 2 patients underwent contemporary CTO PCI, which utilizes new techniques and devices following a pre-defined algorithm.
The study cohort included a total of 447 patients (75.2% male, mean 62.93 ± 11.13 year) with coronary CTOs. Contemporary CTO PCI (cohort 2) was performed in 60 patients and historical CTO intervention (cohort 1) in 387 subjects. Patients in cohort 2 were significantly younger (64.19 ±11.01 vs. 66.0 ± 10.83, P<0.001), with more male (86.7vs 73.4, P=0.027) and with higher incidences of coronary artery disease, percutaneous coronary intervention, peripheral vascular disease and heart failure. The following were also observed in the contemporary CTO PCI group: Higher percentages of left main coronary artery, right coronary artery and ostial lesions treated, more adjunctive use of rotational atherectomy, and implantation only of drug-eluting stents. In complete contrast to its non-usage in the historical CTO PCI group, retrograde approaches were attempted in about a quarter of patients in the new program (23%). Procedural time was significantly longer (176.37 ± 68.36 vs 76.35 ± 35.12 min, P<0.001) and the amount of contrast used was also higher (256.4 ± 106.9 vs 193.64 ± 95.57 ml, P<0.001) in patients intervened using the new algorithm. Procedural success rate was statistically significantly higher in the contemporary CTO PCI group than in historical CTO PCI patients (93.5vs 84.0%, P=0.047). There were no significant differences in hematoma, limb ischemia, major & minor bleeding, need for blood transfusion and vascular complications between the two groups.
Higher risk patients with significantly more complex lesions were treated in the contemporary CTO PCI cohort. Utilization of new techniques and devices with a pre-defined working algorithm significantly improved the procedural success as compared to the historical CTO PCI group.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)