In-hospital Outcomes of Attempting More Than One Chronic Total Coronary Occlusion Through Percutaneous Intervention During the Same Procedure

Peter Tajti, Khaldoon Alaswad, Dimitri Karmpaliotis, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, James W. Choi, M. Nicholas Burke, Anthony H. Doing, Catalin Toma, Barry Uretsky, Elizabeth Holper, R. Michael Wyman, David E. Kandzari, Santiago Garcia, Oleg Krestyaninov, Dmitrii Khelimskii, Michalis Koutouzis, Ioannis TsiafoutisWissam Jaber, Habib Samady, Jeffrey W. Moses, Nicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Darshan Doshi, Iosif Xenogiannis, Bavana V. Rangan, Imre Ungi, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

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Abstract

The frequency and outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of more than one CTO during the same procedure have received limited study. We compared the clinical and angiographic characteristics and procedural outcomes of patients who underwent treatment of single versus >1 CTOs during the same procedure in 20 centers from the United States, Europe, and Russia. A total of 2,955 patients were included: mean age was 65 ± 10 years and 85% were men with high prevalence of previous myocardial infarction (46%), and previous coronary artery bypass graft surgery (33%). More than one CTO lesions were attempted during the same procedure in 58 patients (2.0%) and 70% of them were located in different major epicardial arteries. Compared with patients who underwent PCI of a single CTO, those who underwent PCI of >1 CTOs during the same procedure had similar J-CTO (2.4 ± 1.3 vs 2.5 ± 1.3, p = 0.579) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (1.5 ± 1.2 vs 1.3 ± 1.0 p = 0.147) scores. The multi-CTO PCI group had similar technical success (86% vs 87%, p = 0.633), but higher risk of in-hospital major complications (10.3% vs 2.7%, p = 0.005), and consequently numerically lower procedural success (79% vs 85%, p = 0.197). The multi-CTO PCI group had higher in-hospital mortality (5.2% vs 0.5%, p = 0.005) and stroke (5.2%vs 0.2%, p <0.001), longer procedure duration (162 [117 to 242] vs 122 [80 to 186] minutes, p <0.001) and higher radiation dose (3.6 [2.1 to 6.4] vs 2.9 [1.7 to 4.7] Gray, p = 0.033). In conclusion, staged revascularization may be the preferred approach in patients with >1 CTO lesions requiring revascularization, as treatment during a single procedure was associated with higher risk for periprocedural complications.

Original languageEnglish (US)
Pages (from-to)381-387
Number of pages7
JournalAmerican Journal of Cardiology
Volume122
Issue number3
DOIs
StatePublished - Aug 1 2018

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Coronary Occlusion
Percutaneous Coronary Intervention
Russia
Hospital Mortality
Coronary Artery Bypass
Registries
Arteries
Stroke
Myocardial Infarction
Transplants
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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In-hospital Outcomes of Attempting More Than One Chronic Total Coronary Occlusion Through Percutaneous Intervention During the Same Procedure. / Tajti, Peter; Alaswad, Khaldoon; Karmpaliotis, Dimitri; Jaffer, Farouc A.; Yeh, Robert W.; Patel, Mitul; Mahmud, Ehtisham; Choi, James W.; Burke, M. Nicholas; Doing, Anthony H.; Toma, Catalin; Uretsky, Barry; Holper, Elizabeth; Wyman, R. Michael; Kandzari, David E.; Garcia, Santiago; Krestyaninov, Oleg; Khelimskii, Dmitrii; Koutouzis, Michalis; Tsiafoutis, Ioannis; Jaber, Wissam; Samady, Habib; Moses, Jeffrey W.; Lembo, Nicholas J.; Parikh, Manish; Kirtane, Ajay J.; Ali, Ziad A.; Doshi, Darshan; Xenogiannis, Iosif; Rangan, Bavana V.; Ungi, Imre; Banerjee, Subhash; Brilakis, Emmanouil S.

In: American Journal of Cardiology, Vol. 122, No. 3, 01.08.2018, p. 381-387.

Research output: Contribution to journalArticle

Tajti, P, Alaswad, K, Karmpaliotis, D, Jaffer, FA, Yeh, RW, Patel, M, Mahmud, E, Choi, JW, Burke, MN, Doing, AH, Toma, C, Uretsky, B, Holper, E, Wyman, RM, Kandzari, DE, Garcia, S, Krestyaninov, O, Khelimskii, D, Koutouzis, M, Tsiafoutis, I, Jaber, W, Samady, H, Moses, JW, Lembo, NJ, Parikh, M, Kirtane, AJ, Ali, ZA, Doshi, D, Xenogiannis, I, Rangan, BV, Ungi, I, Banerjee, S & Brilakis, ES 2018, 'In-hospital Outcomes of Attempting More Than One Chronic Total Coronary Occlusion Through Percutaneous Intervention During the Same Procedure', American Journal of Cardiology, vol. 122, no. 3, pp. 381-387. https://doi.org/10.1016/j.amjcard.2018.04.021
Tajti, Peter ; Alaswad, Khaldoon ; Karmpaliotis, Dimitri ; Jaffer, Farouc A. ; Yeh, Robert W. ; Patel, Mitul ; Mahmud, Ehtisham ; Choi, James W. ; Burke, M. Nicholas ; Doing, Anthony H. ; Toma, Catalin ; Uretsky, Barry ; Holper, Elizabeth ; Wyman, R. Michael ; Kandzari, David E. ; Garcia, Santiago ; Krestyaninov, Oleg ; Khelimskii, Dmitrii ; Koutouzis, Michalis ; Tsiafoutis, Ioannis ; Jaber, Wissam ; Samady, Habib ; Moses, Jeffrey W. ; Lembo, Nicholas J. ; Parikh, Manish ; Kirtane, Ajay J. ; Ali, Ziad A. ; Doshi, Darshan ; Xenogiannis, Iosif ; Rangan, Bavana V. ; Ungi, Imre ; Banerjee, Subhash ; Brilakis, Emmanouil S. / In-hospital Outcomes of Attempting More Than One Chronic Total Coronary Occlusion Through Percutaneous Intervention During the Same Procedure. In: American Journal of Cardiology. 2018 ; Vol. 122, No. 3. pp. 381-387.
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abstract = "The frequency and outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of more than one CTO during the same procedure have received limited study. We compared the clinical and angiographic characteristics and procedural outcomes of patients who underwent treatment of single versus >1 CTOs during the same procedure in 20 centers from the United States, Europe, and Russia. A total of 2,955 patients were included: mean age was 65 ± 10 years and 85{\%} were men with high prevalence of previous myocardial infarction (46{\%}), and previous coronary artery bypass graft surgery (33{\%}). More than one CTO lesions were attempted during the same procedure in 58 patients (2.0{\%}) and 70{\%} of them were located in different major epicardial arteries. Compared with patients who underwent PCI of a single CTO, those who underwent PCI of >1 CTOs during the same procedure had similar J-CTO (2.4 ± 1.3 vs 2.5 ± 1.3, p = 0.579) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (1.5 ± 1.2 vs 1.3 ± 1.0 p = 0.147) scores. The multi-CTO PCI group had similar technical success (86{\%} vs 87{\%}, p = 0.633), but higher risk of in-hospital major complications (10.3{\%} vs 2.7{\%}, p = 0.005), and consequently numerically lower procedural success (79{\%} vs 85{\%}, p = 0.197). The multi-CTO PCI group had higher in-hospital mortality (5.2{\%} vs 0.5{\%}, p = 0.005) and stroke (5.2{\%}vs 0.2{\%}, p <0.001), longer procedure duration (162 [117 to 242] vs 122 [80 to 186] minutes, p <0.001) and higher radiation dose (3.6 [2.1 to 6.4] vs 2.9 [1.7 to 4.7] Gray, p = 0.033). In conclusion, staged revascularization may be the preferred approach in patients with >1 CTO lesions requiring revascularization, as treatment during a single procedure was associated with higher risk for periprocedural complications.",
author = "Peter Tajti and Khaldoon Alaswad and Dimitri Karmpaliotis and Jaffer, {Farouc A.} and Yeh, {Robert W.} and Mitul Patel and Ehtisham Mahmud and Choi, {James W.} and Burke, {M. Nicholas} and Doing, {Anthony H.} and Catalin Toma and Barry Uretsky and Elizabeth Holper and Wyman, {R. Michael} and Kandzari, {David E.} and Santiago Garcia and Oleg Krestyaninov and Dmitrii Khelimskii and Michalis Koutouzis and Ioannis Tsiafoutis and Wissam Jaber and Habib Samady and Moses, {Jeffrey W.} and Lembo, {Nicholas J.} and Manish Parikh and Kirtane, {Ajay J.} and Ali, {Ziad A.} and Darshan Doshi and Iosif Xenogiannis and Rangan, {Bavana V.} and Imre Ungi and Subhash Banerjee and Brilakis, {Emmanouil S.}",
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T1 - In-hospital Outcomes of Attempting More Than One Chronic Total Coronary Occlusion Through Percutaneous Intervention During the Same Procedure

AU - Tajti, Peter

AU - Alaswad, Khaldoon

AU - Karmpaliotis, Dimitri

AU - Jaffer, Farouc A.

AU - Yeh, Robert W.

AU - Patel, Mitul

AU - Mahmud, Ehtisham

AU - Choi, James W.

AU - Burke, M. Nicholas

AU - Doing, Anthony H.

AU - Toma, Catalin

AU - Uretsky, Barry

AU - Holper, Elizabeth

AU - Wyman, R. Michael

AU - Kandzari, David E.

AU - Garcia, Santiago

AU - Krestyaninov, Oleg

AU - Khelimskii, Dmitrii

AU - Koutouzis, Michalis

AU - Tsiafoutis, Ioannis

AU - Jaber, Wissam

AU - Samady, Habib

AU - Moses, Jeffrey W.

AU - Lembo, Nicholas J.

AU - Parikh, Manish

AU - Kirtane, Ajay J.

AU - Ali, Ziad A.

AU - Doshi, Darshan

AU - Xenogiannis, Iosif

AU - Rangan, Bavana V.

AU - Ungi, Imre

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - The frequency and outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of more than one CTO during the same procedure have received limited study. We compared the clinical and angiographic characteristics and procedural outcomes of patients who underwent treatment of single versus >1 CTOs during the same procedure in 20 centers from the United States, Europe, and Russia. A total of 2,955 patients were included: mean age was 65 ± 10 years and 85% were men with high prevalence of previous myocardial infarction (46%), and previous coronary artery bypass graft surgery (33%). More than one CTO lesions were attempted during the same procedure in 58 patients (2.0%) and 70% of them were located in different major epicardial arteries. Compared with patients who underwent PCI of a single CTO, those who underwent PCI of >1 CTOs during the same procedure had similar J-CTO (2.4 ± 1.3 vs 2.5 ± 1.3, p = 0.579) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (1.5 ± 1.2 vs 1.3 ± 1.0 p = 0.147) scores. The multi-CTO PCI group had similar technical success (86% vs 87%, p = 0.633), but higher risk of in-hospital major complications (10.3% vs 2.7%, p = 0.005), and consequently numerically lower procedural success (79% vs 85%, p = 0.197). The multi-CTO PCI group had higher in-hospital mortality (5.2% vs 0.5%, p = 0.005) and stroke (5.2%vs 0.2%, p <0.001), longer procedure duration (162 [117 to 242] vs 122 [80 to 186] minutes, p <0.001) and higher radiation dose (3.6 [2.1 to 6.4] vs 2.9 [1.7 to 4.7] Gray, p = 0.033). In conclusion, staged revascularization may be the preferred approach in patients with >1 CTO lesions requiring revascularization, as treatment during a single procedure was associated with higher risk for periprocedural complications.

AB - The frequency and outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of more than one CTO during the same procedure have received limited study. We compared the clinical and angiographic characteristics and procedural outcomes of patients who underwent treatment of single versus >1 CTOs during the same procedure in 20 centers from the United States, Europe, and Russia. A total of 2,955 patients were included: mean age was 65 ± 10 years and 85% were men with high prevalence of previous myocardial infarction (46%), and previous coronary artery bypass graft surgery (33%). More than one CTO lesions were attempted during the same procedure in 58 patients (2.0%) and 70% of them were located in different major epicardial arteries. Compared with patients who underwent PCI of a single CTO, those who underwent PCI of >1 CTOs during the same procedure had similar J-CTO (2.4 ± 1.3 vs 2.5 ± 1.3, p = 0.579) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (1.5 ± 1.2 vs 1.3 ± 1.0 p = 0.147) scores. The multi-CTO PCI group had similar technical success (86% vs 87%, p = 0.633), but higher risk of in-hospital major complications (10.3% vs 2.7%, p = 0.005), and consequently numerically lower procedural success (79% vs 85%, p = 0.197). The multi-CTO PCI group had higher in-hospital mortality (5.2% vs 0.5%, p = 0.005) and stroke (5.2%vs 0.2%, p <0.001), longer procedure duration (162 [117 to 242] vs 122 [80 to 186] minutes, p <0.001) and higher radiation dose (3.6 [2.1 to 6.4] vs 2.9 [1.7 to 4.7] Gray, p = 0.033). In conclusion, staged revascularization may be the preferred approach in patients with >1 CTO lesions requiring revascularization, as treatment during a single procedure was associated with higher risk for periprocedural complications.

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