Frequency and Outcomes of Ad Hoc Versus Planned Chronic Total Occlusion Percutaneous Coronary Intervention: Multicenter Experience

Yader Sandoval, Peter Tajti, Aris Karatasakis, M. Nicholas Burke, Barbara A. Danek, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, Oleg Krestyaninov, Dmitrii Khelimskii, James W. Choi, Anthony H. Doing, Catalin Toma, R. Michael Wyman, Barry Uretsky, Santiago Garcia, Michalis KoutouzisIoannis Tsiafoutis, Elizabeth Holper, Jeffrey W. Moses, Nicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Darshan Doshi, David E. Kandzari, Judit Karacsonyi, Bavana V. Rangan, Craig Thompson, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

Abstract

BACKGROUND: For patients needing coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI), a planned, staged intervention has been recommended by experts. Ad hoc CTO-PCI, however, occurs in practice. METHODS: Observational, contemporary, multicenter, international registry. Our goals were to determine the frequency, characteristics, procedural techniques, and outcomes of patients who underwent ad hoc vs planned CTO-PCI. RESULTS: Among 2282 patients who underwent CTO-PCI between 2012 and 2017, 318 (14%) were ad hoc. Patients undergoing ad hoc CTO-PCI had lower J-CTO, PROGRESS CTO, and PROGRESS Complications scores. Antegrade-wire escalation was used more often in ad hoc PCI (96% vs 81%; P<.001), whereas antegrade-dissection re-entry (22% vs 32%) and retrograde approaches (14% vs 38%) were more common in planned PCI (P<.001). There was no difference in ad hoc vs planned PCI in technical (85% vs 86%) and procedural success (84% vs 84%). In-hospital major adverse cardiac events (MACE) were more common in patients who underwent planned procedures (0.6% vs 2.9%; P=.02). Multivariable analyses showed that ad hoc CTO-PCI was not associated with technical success or MACE. CONCLUSIONS: Ad hoc CTO-PCI occurs more commonly in less complex lesions and is associated with similarly high success rates as planned CTO-PCI in lower J-CTO score lesions, suggesting that ad hoc CTO-PCI may be an acceptable option for experienced hybrid operators in carefully selected cases. Complex cases, as quantified by the J-CTO score, have a higher in-hospital MACE rate and should preferably be performed following proper planning and preparation.

Original languageEnglish (US)
Pages (from-to)133-139
Number of pages7
JournalThe Journal of invasive cardiology
Volume31
Issue number5
StatePublished - May 1 2019

Keywords

  • calcification
  • chronic total occlusion
  • high-risk PCI

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Sandoval, Y., Tajti, P., Karatasakis, A., Burke, M. N., Danek, B. A., Karmpaliotis, D., Alaswad, K., Jaffer, F. A., Yeh, R. W., Patel, M., Mahmud, E., Krestyaninov, O., Khelimskii, D., Choi, J. W., Doing, A. H., Toma, C., Wyman, R. M., Uretsky, B., Garcia, S., ... Brilakis, E. S. (2019). Frequency and Outcomes of Ad Hoc Versus Planned Chronic Total Occlusion Percutaneous Coronary Intervention: Multicenter Experience. The Journal of invasive cardiology, 31(5), 133-139.