In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG). METHODS AND RESULTS: We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32% of total cohort) were older (67±9 versus 63±10 years; P<0.001) and had more comorbidities and lower left ventricular ejection fraction (50% [40-58] versus 55% [45-60]; P<0.001). The CTO target vessel in prior CABG patients was the right coronary artery (56%), circumflex (26%), and left anterior descending artery (17%). The mean J-CTO (2.9±1.2 versus 2.2±1.3; P<0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; 1.5±1.1 versus 1.2±1.0; P<0.001) score was higher in prior CABG patients. Retrograde (53% versus 30%, P<0.001) and antegrade dissection reentry (35% versus 28%; P<0.001) techniques were used more frequently in prior CABG patients. Prior CABG patients had lower technical (84% versus 89%; P<0.001) and procedural (82% versus 87%, P<0.001) success, but similar incidence of in-hospital major complications (3.1% versus 2.5%; P=0.287). In-hospital mortality (1% versus 0.4%; P=0.016) and coronary perforation (7.1% versus 3.1%; P<0.001) occurred more frequently in prior CABG patients, however, CABG patients had a lower incidence of pericardial tamponade (0.1% versus 1.0%; P=0.002) and pericardiocentesis (0% versus 1.3%; P<0.001). CONCLUSIONS: In a large multicenter CTO percutaneous coronary interventions registry, prior CABG patients had lower success rate but similar overall risk for complications, although mortality was higher and the incidence of tamponade was lower. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02061436.

Original languageEnglish (US)
Pages (from-to)e007338
JournalCirculation. Cardiovascular interventions
Volume12
Issue number3
DOIs
StatePublished - Mar 1 2019

Fingerprint

Percutaneous Coronary Intervention
Coronary Artery Bypass
Transplants
Registries
Incidence
Pericardiocentesis
Cardiac Tamponade
Patient Rights
Hospital Mortality
Stroke Volume
Dissection
Comorbidity
Coronary Vessels
Arteries
Clinical Trials
Mortality

Keywords

  • chronic total occlusion
  • coronary bypass graft surgery
  • outcomes
  • percutaneous coronary intervention
  • perforation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery. / Tajti, Peter; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A.; Yeh, Robert W.; Patel, Mitul; Mahmud, Ehtisham; Choi, James W.; Burke, M. Nicholas; Doing, Anthony H.; Dattilo, Phil; Toma, Catalin; Smith, A. J.Conrad; Uretsky, Barry; Holper, Elizabeth; Potluri, Srinivas; 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; Stanberry, Larissa I.; Rangan, Bavana V.; Ungi, Imre; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Circulation. Cardiovascular interventions, Vol. 12, No. 3, 01.03.2019, p. e007338.

Research output: Contribution to journalArticle

Tajti, P, Karmpaliotis, D, Alaswad, K, Jaffer, FA, Yeh, RW, Patel, M, Mahmud, E, Choi, JW, Burke, MN, Doing, AH, Dattilo, P, Toma, C, Smith, AJC, Uretsky, B, Holper, E, Potluri, S, 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, Stanberry, LI, Rangan, BV, Ungi, I, Banerjee, S & Brilakis, ES 2019, 'In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery', Circulation. Cardiovascular interventions, vol. 12, no. 3, pp. e007338. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007338
Tajti, Peter ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Jaffer, Farouc A. ; Yeh, Robert W. ; Patel, Mitul ; Mahmud, Ehtisham ; Choi, James W. ; Burke, M. Nicholas ; Doing, Anthony H. ; Dattilo, Phil ; Toma, Catalin ; Smith, A. J.Conrad ; Uretsky, Barry ; Holper, Elizabeth ; Potluri, Srinivas ; 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 ; Stanberry, Larissa I. ; Rangan, Bavana V. ; Ungi, Imre ; Banerjee, Subhash ; Brilakis, Emmanouil S. / In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery. In: Circulation. Cardiovascular interventions. 2019 ; Vol. 12, No. 3. pp. e007338.
@article{54001bef16be463b93f1b3241372cd9e,
title = "In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery",
abstract = "BACKGROUND: We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG). METHODS AND RESULTS: We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32{\%} of total cohort) were older (67±9 versus 63±10 years; P<0.001) and had more comorbidities and lower left ventricular ejection fraction (50{\%} [40-58] versus 55{\%} [45-60]; P<0.001). The CTO target vessel in prior CABG patients was the right coronary artery (56{\%}), circumflex (26{\%}), and left anterior descending artery (17{\%}). The mean J-CTO (2.9±1.2 versus 2.2±1.3; P<0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; 1.5±1.1 versus 1.2±1.0; P<0.001) score was higher in prior CABG patients. Retrograde (53{\%} versus 30{\%}, P<0.001) and antegrade dissection reentry (35{\%} versus 28{\%}; P<0.001) techniques were used more frequently in prior CABG patients. Prior CABG patients had lower technical (84{\%} versus 89{\%}; P<0.001) and procedural (82{\%} versus 87{\%}, P<0.001) success, but similar incidence of in-hospital major complications (3.1{\%} versus 2.5{\%}; P=0.287). In-hospital mortality (1{\%} versus 0.4{\%}; P=0.016) and coronary perforation (7.1{\%} versus 3.1{\%}; P<0.001) occurred more frequently in prior CABG patients, however, CABG patients had a lower incidence of pericardial tamponade (0.1{\%} versus 1.0{\%}; P=0.002) and pericardiocentesis (0{\%} versus 1.3{\%}; P<0.001). CONCLUSIONS: In a large multicenter CTO percutaneous coronary interventions registry, prior CABG patients had lower success rate but similar overall risk for complications, although mortality was higher and the incidence of tamponade was lower. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02061436.",
keywords = "chronic total occlusion, coronary bypass graft surgery, outcomes, percutaneous coronary intervention, perforation",
author = "Peter Tajti and Dimitri Karmpaliotis and Khaldoon Alaswad 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 Phil Dattilo and Catalin Toma and Smith, {A. J.Conrad} and Barry Uretsky and Elizabeth Holper and Srinivas Potluri 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 Stanberry, {Larissa I.} and Rangan, {Bavana V.} and Imre Ungi and Subhash Banerjee and Brilakis, {Emmanouil S.}",
year = "2019",
month = "3",
day = "1",
doi = "10.1161/CIRCINTERVENTIONS.118.007338",
language = "English (US)",
volume = "12",
pages = "e007338",
journal = "Circulation: Cardiovascular Interventions",
issn = "1941-7640",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery

AU - Tajti, Peter

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

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 - Dattilo, Phil

AU - Toma, Catalin

AU - Smith, A. J.Conrad

AU - Uretsky, Barry

AU - Holper, Elizabeth

AU - Potluri, Srinivas

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 - Stanberry, Larissa I.

AU - Rangan, Bavana V.

AU - Ungi, Imre

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - BACKGROUND: We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG). METHODS AND RESULTS: We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32% of total cohort) were older (67±9 versus 63±10 years; P<0.001) and had more comorbidities and lower left ventricular ejection fraction (50% [40-58] versus 55% [45-60]; P<0.001). The CTO target vessel in prior CABG patients was the right coronary artery (56%), circumflex (26%), and left anterior descending artery (17%). The mean J-CTO (2.9±1.2 versus 2.2±1.3; P<0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; 1.5±1.1 versus 1.2±1.0; P<0.001) score was higher in prior CABG patients. Retrograde (53% versus 30%, P<0.001) and antegrade dissection reentry (35% versus 28%; P<0.001) techniques were used more frequently in prior CABG patients. Prior CABG patients had lower technical (84% versus 89%; P<0.001) and procedural (82% versus 87%, P<0.001) success, but similar incidence of in-hospital major complications (3.1% versus 2.5%; P=0.287). In-hospital mortality (1% versus 0.4%; P=0.016) and coronary perforation (7.1% versus 3.1%; P<0.001) occurred more frequently in prior CABG patients, however, CABG patients had a lower incidence of pericardial tamponade (0.1% versus 1.0%; P=0.002) and pericardiocentesis (0% versus 1.3%; P<0.001). CONCLUSIONS: In a large multicenter CTO percutaneous coronary interventions registry, prior CABG patients had lower success rate but similar overall risk for complications, although mortality was higher and the incidence of tamponade was lower. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02061436.

AB - BACKGROUND: We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG). METHODS AND RESULTS: We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32% of total cohort) were older (67±9 versus 63±10 years; P<0.001) and had more comorbidities and lower left ventricular ejection fraction (50% [40-58] versus 55% [45-60]; P<0.001). The CTO target vessel in prior CABG patients was the right coronary artery (56%), circumflex (26%), and left anterior descending artery (17%). The mean J-CTO (2.9±1.2 versus 2.2±1.3; P<0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; 1.5±1.1 versus 1.2±1.0; P<0.001) score was higher in prior CABG patients. Retrograde (53% versus 30%, P<0.001) and antegrade dissection reentry (35% versus 28%; P<0.001) techniques were used more frequently in prior CABG patients. Prior CABG patients had lower technical (84% versus 89%; P<0.001) and procedural (82% versus 87%, P<0.001) success, but similar incidence of in-hospital major complications (3.1% versus 2.5%; P=0.287). In-hospital mortality (1% versus 0.4%; P=0.016) and coronary perforation (7.1% versus 3.1%; P<0.001) occurred more frequently in prior CABG patients, however, CABG patients had a lower incidence of pericardial tamponade (0.1% versus 1.0%; P=0.002) and pericardiocentesis (0% versus 1.3%; P<0.001). CONCLUSIONS: In a large multicenter CTO percutaneous coronary interventions registry, prior CABG patients had lower success rate but similar overall risk for complications, although mortality was higher and the incidence of tamponade was lower. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02061436.

KW - chronic total occlusion

KW - coronary bypass graft surgery

KW - outcomes

KW - percutaneous coronary intervention

KW - perforation

UR - http://www.scopus.com/inward/record.url?scp=85062994853&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062994853&partnerID=8YFLogxK

U2 - 10.1161/CIRCINTERVENTIONS.118.007338

DO - 10.1161/CIRCINTERVENTIONS.118.007338

M3 - Article

C2 - 30871357

AN - SCOPUS:85062994853

VL - 12

SP - e007338

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

SN - 1941-7640

IS - 3

ER -