Predictors and Outcomes of Side-Branch Occlusion in Coronary Chronic Total Occlusion Interventions

Phuong Khanh J Nguyen-Trong, Bavana V. Rangan, Aris Karatasakis, Barbara A. Danek, Georgios E. Christakopoulos, Jose Roberto Martinez-Parachini, Erica Resendes, Colby R. Ayers, Michael Luna, Shuaib Abdullah, Dharam J. Kumbhani, Tayo Addo, Jerrold Grodin, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Objectives: We investigated whether side-branch loss during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) could adversely impact clinical outcomes. Background: Side-branch occlusion during PCI has been associated with periprocedural myocardial infarction and higher incidence of major adverse cardiac event (MACE), but has received limited study in CTO-PCI. METHODS: We retrospectively reviewed the medical records and coronary angiograms for 109 consecutive CTOPCI cases performed at our institution during 2012 and 2013. Post-PCI patency of ≥1 mm diameter side branches and associated clinical outcomes were assessed. RESULTS: Mean age was 65 ± 8 years and 99.1% of the patients were men. The CTO target vessel was the right coronary artery (54%), circumflex (26%), and left anterior descending artery (20%). Side-branch loss occurred in 28 cases (25.7%) due to antegrade dissection/reentry (n ≤ 9), retrograde dissection/reentry (n ≤ 5), stenting over the branch (n ≤ 12), and dissection during antegrade crossing attempts (n ≤ 2). Recanalization of the occluded side branch was pursued in 8 cases (28.6%) and was successful in 4 patients. Patients with side-branch loss had higher post-PCI increase in CK-MB levels (8.4 ng/mL [interquartile range, 2.7-33.5 ng/mL] vs 1.8 ng/mL [interquartile range, 0.025-6.775 ng/mL]; P<.001) and higher 12-month incidence of all-cause death (17.3% vs 2.8%; P≤.02) and cardiovascular death (7.4% vs 0.0%; P≤.02). CONCLUSIONS: Side-branch loss occurs in approximately 1 in 4 CTO-PCIs and is associated with higher risk for periprocedural myocardial infarction and higher mortality.

Original languageEnglish (US)
Pages (from-to)168-173
Number of pages6
JournalJournal of Invasive Cardiology
Volume28
Issue number4
StatePublished - Apr 2016

Keywords

  • chronic total occlusion
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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