Author + information
- Ignacio Amat-Santos1,
- Victoria Martin Yuste2,
- Jose Antonio Fernandez Diaz3,
- Javier Martin-Moreiras4,
- Pablo Salinas5,
- Beatriz Vaquerizo6,
- Laura Pardo7,
- Julio Núñez Villota8,
- Fernando Rivero9,
- Juan Caballero-Borrego10,
- Jose de la Torre Hernandez11 and
- Itziar Gomez12
- 1Institute of heart sciences (ICICOR) - Hospital Clínico Universitario, Valladolid, Spain
- 2hospital clinic barcelona, barcelona, Spain
- 3Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- 4University Hospital of Salamanca, Salamanca, Spain
- 5Hospital Clínico San Carlos, Madrid, Spain
- 6Hospital del Mar, Barcelona, Spain
- 7Reina Sofia Hospital, Córdoba, Spain
- 8Hospital Clinico Valencia, Valencia, Spain
- 9hospital la princesa, Madrid, Spain
- 10Complejo Hospitalario Universitario de Granada, Granada, Spain
- 11Hospital Universitario Marques de Valdecilla, Santander, Spain
- 12Institute of Heart Sciences, Valladolid, Spain
Current controversy regarding the benefits of percutaneous recanalization (PCI) of coronary chronic total occlusions (CTOs) could be partially related to mixed results across different institutions. We summarize the global results of the Iberian Registry from more than 20 Spanish centers.
Prospective registry with specific online database of all patients undergoing PCI of CTOs across 24 centers along 2 years. Follow up was available for 99% of the patients.
A total of 1001 PCIs of a CTO were performed in 952 pacients along 2 years. Most patients were symptomatic (81.5%), with chronic ischemic cardiomyopathy (56.3%) and previous attempts of desobstruction of the CTO in 15%. Mean anatomic Syntax score was 22.4±9.9 (including left main disease in 3.9% and more than one CTO in 13.1%) and J-score≥3 in 17.3%. Right coronary artery was the most commonly affected (49.7%). Retrograde procedure was performed in 107 pacients (10.7%), in 75% as initial approach. Success rate was 74.9% being higher in those without previous attempts (82.2 vs. 75.2%, p=0.001), a J-Score≤2 (80.5 vs. 69.5%, p=0.002), and when IVUS was used (89.9% vs. 76.2%, p=0.001). Indeed, use of IVUS was an independent predictor of success (OR=2.165, IC95%(1.074-4.365), P=0.031). On the contrary, severe calcification (OR=0.455, IC95%(0.267-0.773), P=0.004), length >20 mm (OR=0.424, IC95%(0.273-0.657), P<0.001), and blunt proximal cap (OR=0.421, IC95%(0.272-0.652), P<0.001) were independent predictors of failed recanalization. The rate of procedural complications was 7.1%, including coronary perforation (3%), cardiac tamponade (1%), myocardial infarction (1.3%), or death (0.5%). Independent predictors of complication included prior ischemic cardiomyopathy (OR=2.230, IC95%(1.104-4.505), P=0.025), blunt proximal cap (OR=2.068, IC95%(1.088-3.934), P=0.027), and retrograde approach (OR=3.527, IC95%(1.691-7.359), P=0.001). At a mean follow up of 209±233 days, 77.9% presented clinical improvement that was less likely in case of PCI failure (34.8 vs. 88.2%, p<0.001) or of other clinical conditions associated to functional decline as peripheral artery disease (61.8 vs. 80.3%, p=0.002) or cerebrovascular disease (61.3 vs. 79.7%, p=0.015). Follow up mortality rate was 1.1%.
As compared to other national registries, pacients from the Iberian Registry undergoing PCI of CTOs presented similar complexity, success rate, and complications. A higher use of IVUS and further training in retrograde approach or alternative strategies may be helpful to improve outcomes.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)