Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry

Barbara A. Danek, Aris Karatasakis, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul P. Patel, John Bahadorani, William L. Lombardi, R. Michael Wyman, J. Aaron Grantham, David E. Kandzari, Nicholas J. Lembo, Anthony H. Doing, Catalin Toma, Jeffrey W. Moses, Ajay J. Kirtane, Ziad A. Ali, Manish Parikh, Santiago GarciaPhuong Khanh Nguyen-Trong, Judit Karacsonyi, Aya J. Alame, Pratik Kalsaria, Craig Thompson, Subhash Banerjee, Emmanouil S. Brilakis

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Abstract

Background: We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres. Results: Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; . P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; . P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; . P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs 89.6% vs 93.0%; . P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; . P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; . P = 0.31) for older vs younger occlusions. Conclusions: Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success.

Original languageEnglish (US)
JournalCanadian Journal of Cardiology
DOIs
StateAccepted/In press - Mar 15 2016

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Percutaneous Coronary Intervention
Registries
Dissection
Coronary Artery Bypass
Incidence

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

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Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention : Insights From a Contemporary US Multicenter Registry. / Danek, Barbara A.; Karatasakis, Aris; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A.; Yeh, Robert W.; Patel, Mitul P.; Bahadorani, John; Lombardi, William L.; Wyman, R. Michael; Grantham, J. Aaron; Kandzari, David E.; Lembo, Nicholas J.; Doing, Anthony H.; Toma, Catalin; Moses, Jeffrey W.; Kirtane, Ajay J.; Ali, Ziad A.; Parikh, Manish; Garcia, Santiago; Nguyen-Trong, Phuong Khanh; Karacsonyi, Judit; Alame, Aya J.; Kalsaria, Pratik; Thompson, Craig; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Canadian Journal of Cardiology, 15.03.2016.

Research output: Contribution to journalArticle

Danek, BA, Karatasakis, A, Karmpaliotis, D, Alaswad, K, Jaffer, FA, Yeh, RW, Patel, MP, Bahadorani, J, Lombardi, WL, Wyman, RM, Grantham, JA, Kandzari, DE, Lembo, NJ, Doing, AH, Toma, C, Moses, JW, Kirtane, AJ, Ali, ZA, Parikh, M, Garcia, S, Nguyen-Trong, PK, Karacsonyi, J, Alame, AJ, Kalsaria, P, Thompson, C, Banerjee, S & Brilakis, ES 2016, 'Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry', Canadian Journal of Cardiology. https://doi.org/10.1016/j.cjca.2016.04.007
Danek, Barbara A. ; Karatasakis, Aris ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Jaffer, Farouc A. ; Yeh, Robert W. ; Patel, Mitul P. ; Bahadorani, John ; Lombardi, William L. ; Wyman, R. Michael ; Grantham, J. Aaron ; Kandzari, David E. ; Lembo, Nicholas J. ; Doing, Anthony H. ; Toma, Catalin ; Moses, Jeffrey W. ; Kirtane, Ajay J. ; Ali, Ziad A. ; Parikh, Manish ; Garcia, Santiago ; Nguyen-Trong, Phuong Khanh ; Karacsonyi, Judit ; Alame, Aya J. ; Kalsaria, Pratik ; Thompson, Craig ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention : Insights From a Contemporary US Multicenter Registry. In: Canadian Journal of Cardiology. 2016.
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abstract = "Background: We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres. Results: Mean patient age was 66 ± 10 years and 85.6{\%} of the patients were men. Overall technical and procedural success rates were 90.1{\%} and 87.5{\%}, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1{\%}). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; . P = 0.009), previous coronary artery bypass grafting (62{\%} vs 42{\%} vs 30{\%}; . P < 0.001), and moderate/severe calcification (75{\%} vs 53{\%} vs 59{\%}; . P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8{\%} vs 89.6{\%} vs 93.0{\%}; . P = 0.37) or procedural (86.3{\%} vs 87.4{\%} vs 89.0{\%}; . P = 0.80) success, or the incidence of MACE (3.1{\%} vs 3.0{\%} vs 6.3{\%}; . P = 0.31) for older vs younger occlusions. Conclusions: Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success.",
author = "Danek, {Barbara A.} and Aris Karatasakis and Dimitri Karmpaliotis and Khaldoon Alaswad and Jaffer, {Farouc A.} and Yeh, {Robert W.} and Patel, {Mitul P.} and John Bahadorani and Lombardi, {William L.} and Wyman, {R. Michael} and Grantham, {J. Aaron} and Kandzari, {David E.} and Lembo, {Nicholas J.} and Doing, {Anthony H.} and Catalin Toma and Moses, {Jeffrey W.} and Kirtane, {Ajay J.} and Ali, {Ziad A.} and Manish Parikh and Santiago Garcia and Nguyen-Trong, {Phuong Khanh} and Judit Karacsonyi and Alame, {Aya J.} and Pratik Kalsaria and Craig Thompson and Subhash Banerjee and Brilakis, {Emmanouil S.}",
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T1 - Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention

T2 - Insights From a Contemporary US Multicenter Registry

AU - Danek, Barbara A.

AU - Karatasakis, Aris

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Jaffer, Farouc A.

AU - Yeh, Robert W.

AU - Patel, Mitul P.

AU - Bahadorani, John

AU - Lombardi, William L.

AU - Wyman, R. Michael

AU - Grantham, J. Aaron

AU - Kandzari, David E.

AU - Lembo, Nicholas J.

AU - Doing, Anthony H.

AU - Toma, Catalin

AU - Moses, Jeffrey W.

AU - Kirtane, Ajay J.

AU - Ali, Ziad A.

AU - Parikh, Manish

AU - Garcia, Santiago

AU - Nguyen-Trong, Phuong Khanh

AU - Karacsonyi, Judit

AU - Alame, Aya J.

AU - Kalsaria, Pratik

AU - Thompson, Craig

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2016/3/15

Y1 - 2016/3/15

N2 - Background: We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres. Results: Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; . P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; . P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; . P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs 89.6% vs 93.0%; . P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; . P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; . P = 0.31) for older vs younger occlusions. Conclusions: Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success.

AB - Background: We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres. Results: Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; . P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; . P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; . P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs 89.6% vs 93.0%; . P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; . P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; . P = 0.31) for older vs younger occlusions. Conclusions: Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success.

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