Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry

Ilias Nikolakopoulos, Evangelia Vemmou, Judit Karacsonyi, Khaldoon Alaswad, Dimitri Karmpaliotis, Nidal Abi Rafeh, Daniel Schimmel, Keith Benzuly, James D. Flaherty, Paul Poommipanit, Ahmed M. ElGuindy, M. Nicholas Burke, Emmanouil S. Brilakis

Research output: Contribution to journalLetterpeer-review

Abstract

Background: The impact of bifurcations at the proximal or distal cap on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the clinical, angiographic, and procedural data of 4,584 cases performed in patients between 2012 and 2020 in a global CTO PCI registry. We compared 4 groups according to the bifurcation location: “proximal cap,” “distal cap,” “proximal and distal cap,” and “no bifurcation.” Results: The CTO involved a bifurcation in 67% cases, as follows: proximal cap (n = 1451, 33%), distal cap (n = 622, 14%), or both caps (n = 954, 21%). “Proximal and distal cap” cases had higher J-CTO compared with “proximal cap,” “distal cap,” and “no bifurcation” cases (2.9 ± 1.1 vs 2.5 ± 1.1 vs 2.4 ± 1.2 vs 2.0 ± 1.2, P < 0.0001), and they were also associated with a lower technical success rate (79% vs 85% vs 85% vs 90%, P < 0.0001), higher pericardiocentesis rate (1% vs 1% vs 0.2% vs 0.3%, P = 0.02), and higher emergency coronary artery bypass graft surgery rate (0.3% vs 0% vs 0% vs 0%, P = 0.01). Conclusion: More than two-thirds of CTO PCIs involve a bifurcation, which is associated with lower technical success and higher risk of complications.

Original languageEnglish (US)
Pages (from-to)80-83
Number of pages4
JournalHellenic Journal of Cardiology
Volume66
DOIs
StatePublished - Jul 1 2022
Externally publishedYes

Keywords

  • bifurcation
  • chronic total occlusion
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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