Angiographic success and procedural complications in patients undergoing retrograde percutaneous coronary chronic total occlusion interventions: A weighted meta-analysis of 3482 patients from 26 studies

Abdallah El Sabbagh, Vishal G. Patel, Omar M. Jeroudi, Tesfaldet T. Michael, Mohammed E. Alomar, Owen Mogabgab, Eric Fuh, Michele Roesle, Bavana V. Rangan, Shuaib Abdullah, Jeffrey L. Hastings, Jerrold Grodin, Dharam J. Kumbhani, Dimitrios Alexopoulos, Panayotis Fasseas, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalReview articlepeer-review

70 Scopus citations

Abstract

Background The efficacy and safety profile of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We sought to perform a weighted meta-analysis of the success and complication rates of retrograde CTO PCI. Methods We conducted a meta-analysis of 26 studies published between 2006 and April 2013 reporting in-hospital outcomes of retrograde CTO PCI. Data on procedural success, frequency of death, emergent coronary artery bypass graft surgery (CABG), stroke, myocardial infarction (MI), perforation, tamponade, stent thrombosis, major vascular or bleeding events, contrast nephropathy, and radiation skin injury were collected. Results A total of 26 studies with 3482 patients and 3493 target CTO lesions were included. Primary retrograde CTO PCI was attempted in 52.4%. Pooled estimates of outcomes were as follows: procedural success 83.3% [95% confidence interval (CI): 79.0% to 87.7%]; death 0.7% (95% CI: 0.5% to 1.2%); urgent CABG 0.7% (95% CI: 0.4% to 1.2%); tamponade 1.4% (95% CI: 1.0% to 2.2%); collateral perforation 6.9% (95% CI: 4.6% to 10.4%); coronary perforation 4.3% (95% CI: 1.2% to 15.4%); donor vessel dissection 2% (95% CI: 0.9% to 4.5%); stroke 0.5% (95% CI: 0.2% to 1.0%); MI 3.1% (95% CI: 0.2% to 5.0%); Q wave MI 0.6% (95% CI: 0.4% to 1.1%); vascular access complications 2% (95% CI: 0.9% to 4.5%); contrast nephropathy 1.8% (95% CI: 0.8% to 3.7%); and wire fracture and equipment entrapment 1.2% (95% CI: 0.6% to 2.5%). Conclusions Retrograde CTO PCI is associated with high procedural success rate and acceptable risk for procedural complications.

Original languageEnglish (US)
Pages (from-to)243-248
Number of pages6
JournalInternational Journal of Cardiology
Volume174
Issue number2
DOIs
StatePublished - Jun 15 2014

Keywords

  • Chronic total occlusion
  • Complications
  • Outcomes
  • Percutaneous coronary intervention
  • Retrograde

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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