Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from a Multicenter U.S. Registry

Barbara A. Danek, Mir B. Basir, William W. O'Neill, Mohammad Alqarqaz, Aris Karatasakis, Dimitri Karmpaliotis, Farouc A. Jaffer, Robert W. Yeh, Michael Wyman, William L. Lombardi, David Kandzari, Nicholas Lembo, Anthony Doing, Mitul Patel, Ehtisham Mahmud, James W. Choi, Catalin Toma, Jeffrey W. Moses, Ajay Kirtane, Manish ParikhZiad A. Ali, Santiago Garcia, Judit Karacsonyi, Bavana V. Rangan, Craig A. Thompson, Subhash Banerjee, Emmanouil S. Brilakis, Khaldoon Alaswad

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To study outcomes with use of percutaneous mechanical circulatory support (MCS) devices in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We examined characteristics and outcomes of 1598 CTO-PCIs performed from 2012-2017 at 12 high-volume centers. RESULTS: Patient age was 66 ± 10 years; 86% were men. An MCS device was used electively in 69 procedures (4%) and urgently in 22 procedures (1%). The most commonly used elective MCS device was Impella 2.5 or CP (62%). Compared to patients without elective MCS, patients with elective MCS had higher prevalence of prior heart failure (55% vs 29%; P<.001), prior coronary artery bypass graft surgery (49% vs 35%; P≤.02), and lower left ventricular ejection fraction (34 ± 14% vs 50 ± 14%; P<.001). MCS patients had a higher prevalence of moderate/ severe calcification (88% vs 55%; P<.001) and higher J-CTO scores (3.1 ± 1.2 vs 2.6 ± 1.2; P<.01), and a greater proportion underwent retrograde crossing attempts (55% vs 39%; P<.01). Despite more complex characteristics in MCS patients, technical success rates (88% vs 87%; P≤.70) and procedural success rates (83% vs 87%; P≤.32) were similar in the two groups. Use of elective MCS was associated with longer procedure and fluoroscopy times, and higher incidences of in-hospital major adverse cardiovascular events (8.7% vs 2.5%; P<.01) and bleeding (7.3% vs 1.0%; P<.001). CONCLUSION: Elective MCS was used in 4% of patients undergoing CTO-PCI. Despite more complex clinical and angiographic characteristics, elective use of MCS in high-risk patients is associated with similar technical and procedural success rates, but higher risk of complications, compared to cases without elective MCS.

Original languageEnglish (US)
Pages (from-to)81-87
Number of pages7
JournalJournal of Invasive Cardiology
Volume30
Issue number3
StatePublished - Mar 1 2018

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Keywords

  • chronic total occlusion
  • complications
  • mechanical circulatory support
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Danek, B. A., Basir, M. B., O'Neill, W. W., Alqarqaz, M., Karatasakis, A., Karmpaliotis, D., Jaffer, F. A., Yeh, R. W., Wyman, M., Lombardi, W. L., Kandzari, D., Lembo, N., Doing, A., Patel, M., Mahmud, E., Choi, J. W., Toma, C., Moses, J. W., Kirtane, A., ... Alaswad, K. (2018). Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from a Multicenter U.S. Registry. Journal of Invasive Cardiology, 30(3), 81-87.