TY - JOUR
T1 - Outcomes of retrograde chronic total occlusion percutaneous coronary intervention
T2 - A report from the OPEN-CTO registry
AU - Kalra, Sanjog
AU - Doshi, Darshan
AU - Sapontis, James
AU - Kosmidou, Ioanna
AU - Kirtane, Ajay J.
AU - Moses, Jeffrey W.
AU - Riley, Robert F.
AU - Jones, Philip
AU - Nicholson, William J.
AU - Salisbury, Adam C.
AU - Lombardi, William L.
AU - McCabe, James M.
AU - Pershad, Ashish
AU - Hirai, Taishi
AU - Hakemi, Emad
AU - Russo, Juan J.
AU - Prasad, Megha
AU - Ahmad, Yousif
AU - Hatem, Raja
AU - Gkargkoulas, Fotis
AU - Spertus, John A.
AU - Wyman, R. Michael
AU - Jaffer, Farouc
AU - Spaedy, Anthony
AU - Cook, Stephen
AU - Marso, Steven P.
AU - Nugent, Karen
AU - Federici, Robert
AU - Yeh, Robert W.
AU - Leon, Martin B.
AU - Stone, Gregg W.
AU - Ali, Ziad A.
AU - Parikh, Manish A.
AU - Maehara, Akiko
AU - Cohen, David J.
AU - Batres, Candido
AU - Grantham, J. Aaron
AU - Karmpaliotis, Dimitri
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Objectives: We sought to assess in-hospital and long-term outcomes of retrograde compared with antegrade-only percutaneous coronary intervention for chronic total occlusion (CTO PCI). Background: Procedural and clinical outcomes following retrograde compared with antegrade-only CTO PCI remain unknown. Methods: Using the core-lab adjudicated OPEN-CTO registry, we compared the outcomes of retrograde to antegrade-only CTO PCI. Primary endpoints included were in-hospital major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, stroke, myocardial infarction [MI], emergency cardiac surgery, or clinically significant perforation) and MACCE at 1-year (all-cause death, MI, stroke, target lesion revascularization, or target vessel reocclusion). Results: Among 885 single CTO procedures from the OPEN-CTO registry, 454 were retrograde and 431 were antegrade-only. Lesion complexity was higher (J-CTO score: 2.7 vs. 1.9; p <.001) and technical success lower (82.4 vs. 94.2%; p <.001) in retrograde compared with antegrade-only procedures. All-cause death was higher in the retrograde group in-hospital (2 vs. 0%; p =.003), but not at 1-year (4.9 vs. 3.3%; p =.29). Compared with antegrade-only procedures, in-hospital MACCE rates (composite of all-cause death, stroke, MI, emergency cardiac surgery, and clinically significant perforation) were higher in the retrograde group (10.8 vs. 3.3%; p <.001) and at 1-year (19.5 vs. 13.9%; p =.03). In sensitivity analyses landmarked at discharge, there was no difference in MACCE rates at 1 year following retrograde versus antegrade-only CTO PCI. Improvements in Seattle Angina Questionnaire Quality of Life scores at 1-year were similar between the retrograde and antegrade-only groups (29.9 vs 30.4; p =.58). Conclusions: In the OPEN-CTO registry, retrograde CTO procedures were associated with higher rates of in-hospital MACCE compared with antegrade-only; however, post-discharge outcomes, including quality of life improvements, were similar between technical modalities.
AB - Objectives: We sought to assess in-hospital and long-term outcomes of retrograde compared with antegrade-only percutaneous coronary intervention for chronic total occlusion (CTO PCI). Background: Procedural and clinical outcomes following retrograde compared with antegrade-only CTO PCI remain unknown. Methods: Using the core-lab adjudicated OPEN-CTO registry, we compared the outcomes of retrograde to antegrade-only CTO PCI. Primary endpoints included were in-hospital major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, stroke, myocardial infarction [MI], emergency cardiac surgery, or clinically significant perforation) and MACCE at 1-year (all-cause death, MI, stroke, target lesion revascularization, or target vessel reocclusion). Results: Among 885 single CTO procedures from the OPEN-CTO registry, 454 were retrograde and 431 were antegrade-only. Lesion complexity was higher (J-CTO score: 2.7 vs. 1.9; p <.001) and technical success lower (82.4 vs. 94.2%; p <.001) in retrograde compared with antegrade-only procedures. All-cause death was higher in the retrograde group in-hospital (2 vs. 0%; p =.003), but not at 1-year (4.9 vs. 3.3%; p =.29). Compared with antegrade-only procedures, in-hospital MACCE rates (composite of all-cause death, stroke, MI, emergency cardiac surgery, and clinically significant perforation) were higher in the retrograde group (10.8 vs. 3.3%; p <.001) and at 1-year (19.5 vs. 13.9%; p =.03). In sensitivity analyses landmarked at discharge, there was no difference in MACCE rates at 1 year following retrograde versus antegrade-only CTO PCI. Improvements in Seattle Angina Questionnaire Quality of Life scores at 1-year were similar between the retrograde and antegrade-only groups (29.9 vs 30.4; p =.58). Conclusions: In the OPEN-CTO registry, retrograde CTO procedures were associated with higher rates of in-hospital MACCE compared with antegrade-only; however, post-discharge outcomes, including quality of life improvements, were similar between technical modalities.
KW - OPEN-CTO
KW - chronic total occlusion
KW - percutaneous coronary intervention
KW - retrograde
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U2 - 10.1002/ccd.29230
DO - 10.1002/ccd.29230
M3 - Article
C2 - 32876381
AN - SCOPUS:85090123357
SN - 1522-1946
VL - 97
SP - 1162
EP - 1173
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 6
ER -