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

4 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery'. Together they form a unique fingerprint.

  • Cite this

    Tajti, P., Karmpaliotis, D., Alaswad, K., Jaffer, F. A., Yeh, R. W., Patel, M., Mahmud, E., Choi, J. W., Burke, M. N., Doing, A. H., Dattilo, P., Toma, C., Smith, A. J. C., Uretsky, B., Holper, E., Potluri, S., Wyman, R. M., Kandzari, D. E., Garcia, S., ... Brilakis, E. S. (2019). In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery. Circulation. Cardiovascular interventions, 12(3), e007338. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007338