Effect of Previous Failure on Subsequent Procedural Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention (from a Contemporary Multicenter Registry)
Judit Karacsonyi, Aris Karatasakis, Dimitri Karmpaliotis, Khaldoon Alaswad, Robert W Yeh, Farouc A Jaffer, Michael R Wyman, William L Lombardi, J Aaron Grantham, David E Kandzari, Nicholas Lembo, Jeffrey W Moses, Ajay J Kirtane, Manish A Parikh, Philip Green, Matthew Finn, Santiago Garcia, Anthony Doing, Mitul Patel, John Bahadorani, Jose Roberto Martinez Parachini, Erica Resendes, Bavana V Rangan, Imre Ungi, Craig A Thompson, Subhash Banerjee, Emmanouil S Brilakis, Judit Karacsonyi, Aris Karatasakis, Dimitri Karmpaliotis, Khaldoon Alaswad, Robert W Yeh, Farouc A Jaffer, Michael R Wyman, William L Lombardi, J Aaron Grantham, David E Kandzari, Nicholas Lembo, Jeffrey W Moses, Ajay J Kirtane, Manish A Parikh, Philip Green, Matthew Finn, Santiago Garcia, Anthony Doing, Mitul Patel, John Bahadorani, Jose Roberto Martinez Parachini, Erica Resendes, Bavana V Rangan, Imre Ungi, Craig A Thompson, Subhash Banerjee, Emmanouil S Brilakis
Abstract
We sought to examine the impact of previous failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic characteristics and procedural outcomes of 1,213 consecutive patients who underwent 1,232 CTO PCIs from 2012 to 2015 at 12 US centers. Mean age was 65 ± 10 years, and 84.8% of patients were men. A previously failed attempt had been performed in 215 patients (17.5%). As compared with patients without previous CTO PCI failure, patients with previous failure had higher Multicenter CTO Registry in Japan CTO score (2.40 ± 1.13 vs 3.28 ± 1.29, p <0.0001) and were more likely to have in-stent restenosis (10.5% vs 28.4%, p <0.0001) and to undergo recanalization attempts using the retrograde approach (41% vs 50%, p = 0.011). Technical (90% vs 88%, p = 0.390) and procedural (89% vs 86%, p = 0.184) success were similar in the 2 study groups; however, median procedure time (125 vs 142 minutes, p = 0.026) and fluoroscopy time (45 vs 55 minutes, p = 0.015) were longer in the previous failure group. In conclusion, a previously failed CTO PCI attempt is associated with higher angiographic complexity, longer procedural duration, and fluoroscopy time, but not with the success and complication rates of subsequent CTO PCI attempts.
Conflict of interest statement
Conflicts of Interest:
Dr Karacsonyi: none
Dr. Karatasakis: none
Dr. Karmpaliotis: speaker bureau, Abbott Vascular, Medtronic, and Boston Scientific
Dr. Alaswad: consulting fees from Terumo and Boston Scientific; consultant, no financial, Abbott Laboratories.
Dr. Yeh: Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute.
Dr. Jaffer: consultant to Boston Scientific, Siemens, and Merck, nonfinancial research support from Abbott Vascular, research grant from National Institutes of Health (HL-R01-108229).
Dr. Wyman: Honoraria/consulting/speaking fees from Boston Scientific, Abbott Vascular, and Asahi.
Dr. Lombardi: equity with Bridgepoint Medical
Dr. Grantham: Speaking fees, consulting, and honoraria from Boston Scientific, Asahi Intecc. Research grants from Boston Scientific, Asahi Intecc, Abbott Vascular, Medtronic.
Dr. Kandzari: research/grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular, and research/grant support from Abbott.
Dr. Lembo: speaker bureau: Medtronic; advisory board Abbott Vascular and Medtronic.
Dr. Moses: none
Dr. Kirtane: Institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, Glaxo SmithKline, and Eli Lilly.
Dr. Parikh: none
Dr. Green: none
Dr. Finn: none
Dr. Garcia: consulting fees from Medtronic
Dr. Doing: none
Dr Patel: none
Dr Bahadorani: none
Dr Parachini: none
Resendes: none
Dr Rangan: none
Dr Ungi: none
Dr. Thompson: employee of Boston Scientific
Dr. Banerjee: research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCARE Global (spouse); intellectual property in HygeiaTel.
Dr. Brilakis: consulting/speaker honoraria from Abbott Vascular, Asahi, Boston Scientific, Elsevier, Somahlution, St Jude Medical, and Terumo; research support from Boston Scientific and InfraRedx; spouse is employee of Medtronic.
Published by Elsevier Inc.
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Source: PubMed