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There is still uncertainty about usefulness of coronary chronic total occlusion (CTO) recanalization regarding improvement of patient survival, despite the great advancement in CTO opening techniques. We explored explore the predictors of 12 months mortality after coronary CTO opening procedure.
During 2 year period (July 2014 – July 2016) all consecutive patients with coronary CTOs treated with antegrade technique were included into database and followed systematically for survival, clinical status (by telephone contact) and rehospitalization. The patients treated by only antegrade approach are presented here. The all last generation CTO wires and microcatheters were used. The parallel, 2 and 3 wires see-saw techniques, LAST, stepwise antegrade dissection and IVUS guided recanalization techniques were used according to operator decision.
For 24 months period a 207 consecutive patients were included in this analysis. The median follow-up time was 15 months (IQR 7-21). The mean age was 68±12 years, 77% males, 39% diabetics, all patients had hypertension, 54% smokers, 37% had renal failure, 38% with previous myocardial infarction, 58% with previous PCI. The mean SYNTAX score of our population was 22±9. The most frequent treated vessel was RCA – 49%, followed by LAD33% and LCX – 18%. The mean stent length was 62±12mm, with diameter 2.93±.31mm with procedure time was 128±27 min, fluoroscopy time 39±12 min, contrast volume 201±32 ml. The primary antegrade-only success rate was 81% and final antegrade only success rate was 87%. The 12-month mortality was 6.8% (14/207) – the mortality rate after successful procedures was 4.8% vs. 15.4% in un-successful PCIs, p=.018. The rate of major complications was 1.9% - 1 intramural hematoma, 2 tamponades, 1 post-PCI STEMI, all treated successfully. There are several significant correlates with one-year mortality: the success of CTO procedure, NYHA class, mitral regurgitation degree, Q-waves on ECG, LAD side branch appearance, microcatheter use, vessel calcification on fluoroscopy, final TIMI flow. On multivariate logistic regression analysis an independent predictors of survival at one year are: successful CTO opening (OR=5.847, 1.381-24.390, p=.016), NYHA class (OR=2.597, 1.293-5.208, p=.007), LAD side branch appearance at CTO start (for unsuccessful procedure OR=9.193, 1.573-53.711, p=.014) and microcatheter use (for successful procedure OR=11.190, 1.311-95.510, p=.027).
The successful opening of coronary CTO with antegrade approach with contemporary armamentarium reduces mortality at 12 months follow-up period.