Application of the "hybrid Approach" to Chronic Total Occlusions in Patients with Previous Coronary Artery Bypass Graft Surgery (from a Contemporary Multicenter US Registry)

Georgios Christopoulos, Rohan V. Menon, Dimitri Karmpaliotis, Khaldoon Alaswad, William Lombardi, J. Aaron Grantham, Tesfaldet T. Michael, Vishal G. Patel, Bavana V. Rangan, Anna P. Kotsia, Nicholas Lembo, David E. Kandzari, James Lee, Anna Kalynych, Harold Carlson, Santiago Garcia, Subhash Banerjee, Craig A. Thompson, Emmanouil S. Brilakis

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Abstract

Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been traditionally associated with lower success rates in patients with previous coronary artery bypass graft surgery (CABG). We sought to examine the success and complication rates of CTO PCI using the "hybrid" crossing algorithm among patients with a history of previous CABG. The procedural outcomes of 496 consecutive CTO PCIs performed at 5 high-volume PCI centers in the United States from January 2012 to August 2013 were assessed. The outcomes of patients with previous CABG were compared with those of patients without previous CABG. Compared with patients without previous CABG (n = 320), patients with previous CABG (n = 176, 35%) were older, had more coronary artery disease risk factors, and had less favorable baseline angiographic CTO characteristics. Technical and procedural success was slightly lower among patients with previous CABG (88.1% vs 93.4%, p = 0.044 and 87.5 vs 92.5%, p = 0.07, respectively). Patients with previous CABG more commonly underwent CTO PCI using the retrograde approach (39% vs 24%, respectively, p <0.001) and received higher air kerma radiation exposure (4.8 [interquartile range 3.0 to 6.4] vs 3.1 [1.9 to 5.3] Gray, p <0.001) and fluoroscopy time (59 [38 to 77] vs 34 [21 to 55] minutes, p <0.001). Major procedural complications were similar in the 2 groups: 2 of 176 (1.1%) patients with previous CABG versus 7 of 320 (2.1%) patients without previous CABG (p = 0.40). In conclusion, with application of the "hybrid" approach to CTO PCI, success was slightly lower, and complication rates were similar between patients with and without previous CABG.

Original languageEnglish (US)
Pages (from-to)1990-1994
Number of pages5
JournalAmerican Journal of Cardiology
Volume113
Issue number12
DOIs
StatePublished - Jun 15 2014

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Christopoulos, G., Menon, R. V., Karmpaliotis, D., Alaswad, K., Lombardi, W., Grantham, J. A., Michael, T. T., Patel, V. G., Rangan, B. V., Kotsia, A. P., Lembo, N., Kandzari, D. E., Lee, J., Kalynych, A., Carlson, H., Garcia, S., Banerjee, S., Thompson, C. A., & Brilakis, E. S. (2014). Application of the "hybrid Approach" to Chronic Total Occlusions in Patients with Previous Coronary Artery Bypass Graft Surgery (from a Contemporary Multicenter US Registry). American Journal of Cardiology, 113(12), 1990-1994. https://doi.org/10.1016/j.amjcard.2014.03.039