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Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is being increasingly performed. Literature suggests that outcome of CTO PCI is significantly influenced by operator experience. This study evaluated the safety, success rate and outcome of CTO PCI in a large UK non-surgical centre amongst operators with variable levels of experience.
Data on all CTO PCI over a 5 year period (2011-2016) was collected retrospectively from the local BCIS database and electronic patient records. Procedural success rate, and periprocedural and 1 year MACE [all-cause mortality, myocardial infarction (MI), cerebrovascular accident and target vessel revascularisation (TVR)] was recorded.
Two-hundred seventy six patients had CTO PCI during the five year period in our centre. 81% were male (n=223). Mean age 65 ± 11 years. 48% (n=133) of procedures were performed trans-radially including single and dual radial access. Lesions treated included LMS 1.4% (n=4), LAD 28.3% (n=78), Cx 19.2% (n=53), RCA 50% (n=138) and intermediate 1.1% (n=3). Techniques used include antegrade wire escalation (AWE) 82.2% (n=227), retrograde wire escalation (RWE) 2.2% (n=6), antegrade dissection re-entry (ADR) 8.7% (n=24) and retrograde dissection re-entry (RDR) 6.9% (n=19). 5% (n=14) of patients had severe LV impairment. Rotablation was used in 5.8% of procedures (n=16) and IVUS guided stenting in 21% (n=58). 76% (n=211) of patients had DES. Success rates were 76% (n=210) at first attempt by all operators and 91% when performed by a high-volume CTO operator. When patients were referred for a second attempt to a high volume CTO operator, the success rate was 89.5%. ADR and RDR techniques were successful in 70%. Complications included: side branch occlusion 3.5%, coronary perforation 4% and cardiac tamponade 1%. In-hospital MACE was 0.7%. 12 month MACE was reported in 3.6%. Death occurred in 1.4%, MI in 1.1%, target lesion revascularisation in 1.8% and cerebrovascular accident in 1.1% (one haemorrhagic stroke day 60 post procedure and two ischaemic strokes).
These results suggest that CTO PCI in a non-surgical centre is safe with excellent outcomes when performed by high volume CTO operators.
CORONARY: PCI Outcomes