Percutaneous Intervention of Circumflex Chronic Total Occlusions Is Associated With Worse Procedural Outcomes: Insights From a Multicentre US Registry

Georgios Christopoulos, Dimitri Karmpaliotis, Michael R. Wyman, Khaldoon Alaswad, James McCabe, William L. Lombardi, J. Aaron Grantham, Steven P. Marso, Anna P. Kotsia, Bavana V. Rangan, Santiago A. Garcia, Nicholas Lembo, David Kandzari, James Lee, Anna Kalynych, Harold Carlson, Craig A. Thompson, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: We sought to determine whether outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary according to CTO target vessel: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). Methods: We evaluated the clinical and angiographic characteristics and procedural outcomes of 636 patients who underwent CTO PCI at 6 high-volume centres in the United States between January 2012 and March2014. Results: The CTO target vessel was the RCA in 387 cases (61%), LAD in 132 (21%), and LCX in 117 (18%). LCX lesions were more tortuous and RCA lesions had greater occlusion length and Japanese Chronic Total Occlusion (J-CTO) score, but were less likely to have a side branch at the proximal cap and had more developed collateral circulation. The rate of procedural success was lower in LCX CTOs (84.6%), followed by RCA (91.7%), and LAD (94.7%) CTOs (. P= 0.016). Major complications tended to occur more frequently in LCX PCI (4.3% vs 1.0% for RCA vs 2.3% for LAD; P= 0.07). LCX and RCA CTO PCI required longer fluoroscopy times (45 [interquartile range (IQR), 30-74] minutes vs 45 [IQR, 21-69] minutes for RCA vs 34 [IQR, 20-60] minutes for LAD; P= 0.018) and LCX CTOs required more contrast administration (280 [IQR, 210-370] mL vs 250 [IQR, 184-350] mL for RCA and 280 [IQR, 200-400] mL for LAD). Conclusions: In a contemporary, multicentre CTO PCI registry, LCX was the least common target vessel. Compared with LAD and RCA, PCI of LCX CTOs was associated with a lower rate of procedural success, less efficiency, and a nonsignificant trend for higher rates of complications.

Original languageEnglish (US)
Pages (from-to)1588-1594
Number of pages7
JournalCanadian Journal of Cardiology
Volume30
Issue number12
DOIs
StatePublished - Dec 1 2014

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Registries
Arteries
Coronary Vessels
Percutaneous Coronary Intervention
Collateral Circulation
Fluoroscopy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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Percutaneous Intervention of Circumflex Chronic Total Occlusions Is Associated With Worse Procedural Outcomes : Insights From a Multicentre US Registry. / Christopoulos, Georgios; Karmpaliotis, Dimitri; Wyman, Michael R.; Alaswad, Khaldoon; McCabe, James; Lombardi, William L.; Grantham, J. Aaron; Marso, Steven P.; Kotsia, Anna P.; Rangan, Bavana V.; Garcia, Santiago A.; Lembo, Nicholas; Kandzari, David; Lee, James; Kalynych, Anna; Carlson, Harold; Thompson, Craig A.; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Canadian Journal of Cardiology, Vol. 30, No. 12, 01.12.2014, p. 1588-1594.

Research output: Contribution to journalArticle

Christopoulos, G, Karmpaliotis, D, Wyman, MR, Alaswad, K, McCabe, J, Lombardi, WL, Grantham, JA, Marso, SP, Kotsia, AP, Rangan, BV, Garcia, SA, Lembo, N, Kandzari, D, Lee, J, Kalynych, A, Carlson, H, Thompson, CA, Banerjee, S & Brilakis, ES 2014, 'Percutaneous Intervention of Circumflex Chronic Total Occlusions Is Associated With Worse Procedural Outcomes: Insights From a Multicentre US Registry', Canadian Journal of Cardiology, vol. 30, no. 12, pp. 1588-1594. https://doi.org/10.1016/j.cjca.2014.07.007
Christopoulos, Georgios ; Karmpaliotis, Dimitri ; Wyman, Michael R. ; Alaswad, Khaldoon ; McCabe, James ; Lombardi, William L. ; Grantham, J. Aaron ; Marso, Steven P. ; Kotsia, Anna P. ; Rangan, Bavana V. ; Garcia, Santiago A. ; Lembo, Nicholas ; Kandzari, David ; Lee, James ; Kalynych, Anna ; Carlson, Harold ; Thompson, Craig A. ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Percutaneous Intervention of Circumflex Chronic Total Occlusions Is Associated With Worse Procedural Outcomes : Insights From a Multicentre US Registry. In: Canadian Journal of Cardiology. 2014 ; Vol. 30, No. 12. pp. 1588-1594.
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abstract = "Background: We sought to determine whether outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary according to CTO target vessel: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). Methods: We evaluated the clinical and angiographic characteristics and procedural outcomes of 636 patients who underwent CTO PCI at 6 high-volume centres in the United States between January 2012 and March2014. Results: The CTO target vessel was the RCA in 387 cases (61{\%}), LAD in 132 (21{\%}), and LCX in 117 (18{\%}). LCX lesions were more tortuous and RCA lesions had greater occlusion length and Japanese Chronic Total Occlusion (J-CTO) score, but were less likely to have a side branch at the proximal cap and had more developed collateral circulation. The rate of procedural success was lower in LCX CTOs (84.6{\%}), followed by RCA (91.7{\%}), and LAD (94.7{\%}) CTOs (. P= 0.016). Major complications tended to occur more frequently in LCX PCI (4.3{\%} vs 1.0{\%} for RCA vs 2.3{\%} for LAD; P= 0.07). LCX and RCA CTO PCI required longer fluoroscopy times (45 [interquartile range (IQR), 30-74] minutes vs 45 [IQR, 21-69] minutes for RCA vs 34 [IQR, 20-60] minutes for LAD; P= 0.018) and LCX CTOs required more contrast administration (280 [IQR, 210-370] mL vs 250 [IQR, 184-350] mL for RCA and 280 [IQR, 200-400] mL for LAD). Conclusions: In a contemporary, multicentre CTO PCI registry, LCX was the least common target vessel. Compared with LAD and RCA, PCI of LCX CTOs was associated with a lower rate of procedural success, less efficiency, and a nonsignificant trend for higher rates of complications.",
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T2 - Insights From a Multicentre US Registry

AU - Christopoulos, Georgios

AU - Karmpaliotis, Dimitri

AU - Wyman, Michael R.

AU - Alaswad, Khaldoon

AU - McCabe, James

AU - Lombardi, William L.

AU - Grantham, J. Aaron

AU - Marso, Steven P.

AU - Kotsia, Anna P.

AU - Rangan, Bavana V.

AU - Garcia, Santiago A.

AU - Lembo, Nicholas

AU - Kandzari, David

AU - Lee, James

AU - Kalynych, Anna

AU - Carlson, Harold

AU - Thompson, Craig A.

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

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N2 - Background: We sought to determine whether outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary according to CTO target vessel: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). Methods: We evaluated the clinical and angiographic characteristics and procedural outcomes of 636 patients who underwent CTO PCI at 6 high-volume centres in the United States between January 2012 and March2014. Results: The CTO target vessel was the RCA in 387 cases (61%), LAD in 132 (21%), and LCX in 117 (18%). LCX lesions were more tortuous and RCA lesions had greater occlusion length and Japanese Chronic Total Occlusion (J-CTO) score, but were less likely to have a side branch at the proximal cap and had more developed collateral circulation. The rate of procedural success was lower in LCX CTOs (84.6%), followed by RCA (91.7%), and LAD (94.7%) CTOs (. P= 0.016). Major complications tended to occur more frequently in LCX PCI (4.3% vs 1.0% for RCA vs 2.3% for LAD; P= 0.07). LCX and RCA CTO PCI required longer fluoroscopy times (45 [interquartile range (IQR), 30-74] minutes vs 45 [IQR, 21-69] minutes for RCA vs 34 [IQR, 20-60] minutes for LAD; P= 0.018) and LCX CTOs required more contrast administration (280 [IQR, 210-370] mL vs 250 [IQR, 184-350] mL for RCA and 280 [IQR, 200-400] mL for LAD). Conclusions: In a contemporary, multicentre CTO PCI registry, LCX was the least common target vessel. Compared with LAD and RCA, PCI of LCX CTOs was associated with a lower rate of procedural success, less efficiency, and a nonsignificant trend for higher rates of complications.

AB - Background: We sought to determine whether outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary according to CTO target vessel: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). Methods: We evaluated the clinical and angiographic characteristics and procedural outcomes of 636 patients who underwent CTO PCI at 6 high-volume centres in the United States between January 2012 and March2014. Results: The CTO target vessel was the RCA in 387 cases (61%), LAD in 132 (21%), and LCX in 117 (18%). LCX lesions were more tortuous and RCA lesions had greater occlusion length and Japanese Chronic Total Occlusion (J-CTO) score, but were less likely to have a side branch at the proximal cap and had more developed collateral circulation. The rate of procedural success was lower in LCX CTOs (84.6%), followed by RCA (91.7%), and LAD (94.7%) CTOs (. P= 0.016). Major complications tended to occur more frequently in LCX PCI (4.3% vs 1.0% for RCA vs 2.3% for LAD; P= 0.07). LCX and RCA CTO PCI required longer fluoroscopy times (45 [interquartile range (IQR), 30-74] minutes vs 45 [IQR, 21-69] minutes for RCA vs 34 [IQR, 20-60] minutes for LAD; P= 0.018) and LCX CTOs required more contrast administration (280 [IQR, 210-370] mL vs 250 [IQR, 184-350] mL for RCA and 280 [IQR, 200-400] mL for LAD). Conclusions: In a contemporary, multicentre CTO PCI registry, LCX was the least common target vessel. Compared with LAD and RCA, PCI of LCX CTOs was associated with a lower rate of procedural success, less efficiency, and a nonsignificant trend for higher rates of complications.

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