Prevalence and Outcomes of Percutaneous Coronary Interventions for Ostial Chronic Total Occlusions: Insights From a Multicenter Chronic Total Occlusion Registry

Peter Tajti, M. Nicholas Burke, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, James W. Choi, Anthony H. Doing, Phil Datilo, Catalin Toma, A. J.Conrad Smith, Barry Uretsky, Elizabeth Holper, Santiago Garcia, Oleg Krestyaninov, Dimitrii Khelimskii, Michalis Koutouzis, Ioannis TsiafoutisJeffrey W. Moses, Nicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Darshan Doshi, Wissam Jaber, Habib Samady, Bavana V. Rangan, Iosif Xenogiannis, Imre Ungi, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

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Abstract

Background: Ostial chronic total occlusions (CTOs) can be challenging to recanalize. Methods: We sought to examine the prevalence, angiographic presentation, and procedural outcomes of ostial (side-branch ostial and aorto-ostial) CTOs among 1000 CTO percutaneous coronary interventions (PCIs) performed in 971 patients between 2015 and 2017 at 14 centres in the US, Europe, and Russia. Results: Ostial CTOs represented 16.9% of all CTO PCIs: 9.6% were aorto-ostial, and 7.3% were side-branch ostial occlusions. Compared with nonostial CTOs, ostial CTOs were longer (44 ± 33 vs 29 ± 19 mm, P < 0.001) and more likely to have proximal-cap ambiguity (55% vs 33%, P < 0.001), moderate/severe calcification (67% vs 45%, P < 0.001), a diffusely diseased distal vessel (41% vs 26%, P < 0.001), interventional collaterals (64% vs 53%, P = 0.012), and previous coronary artery bypass graft surgery (CABG) (51% vs 27%, P < 0.001). The retrograde approach was used more often in ostial CTOs (54% vs 29%, P < 0.001) and was more often the final successful crossing strategy (30% vs 18%, P = 0.003). Technical (81% vs 84%, P = 0.280), and procedural (77% vs 83%, P = 0.112) success rates and the incidence of in-hospital major complication were similar (4.8% vs 2.2%, P = 0.108), yet in-hospital mortality (3.0% vs 0.5%, P = 0.010) and stroke (1.2% vs 0.0%, P = 0.030) were higher in the ostial CTO PCI group. In multivariable analysis, ostial CTO location was not independently associated with higher risk for in-hospital major complications (adjusted odds ratio 1.27, 95% confidence intervals 0.37 to 4.51, P = 0.694). Conclusions: Ostial CTOs can be recanalized with similar rates of success as nonostial CTOs but are more complex, more likely to require retrograde crossing and may be associated with numerically higher risk for major in-hospital complications.

Original languageEnglish (US)
Pages (from-to)1264-1274
Number of pages11
JournalCanadian Journal of Cardiology
Volume34
Issue number10
DOIs
StatePublished - Oct 1 2018

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Tajti, P., Burke, M. N., Karmpaliotis, D., Alaswad, K., Jaffer, F. A., Yeh, R. W., Patel, M., Mahmud, E., Choi, J. W., Doing, A. H., Datilo, P., Toma, C., Smith, A. J. C., Uretsky, B., Holper, E., Garcia, S., Krestyaninov, O., Khelimskii, D., Koutouzis, M., ... Brilakis, E. S. (2018). Prevalence and Outcomes of Percutaneous Coronary Interventions for Ostial Chronic Total Occlusions: Insights From a Multicenter Chronic Total Occlusion Registry. Canadian Journal of Cardiology, 34(10), 1264-1274. https://doi.org/10.1016/j.cjca.2018.07.472