TY - JOUR
T1 - Procedural outcomes of chronic total occlusion percutaneous coronary intervention
T2 - A report from the NCDR (National Cardiovascular Data Registry)
AU - Brilakis, Emmanouil S.
AU - Banerjee, Subhash
AU - Karmpaliotis, Dimitri
AU - Lombardi, William L.
AU - Tsai, Thomas T.
AU - Shunk, Kendrick A.
AU - Kennedy, Kevin F.
AU - Spertus, John A.
AU - Holmes, David R.
AU - Grantham, J. Aaron
N1 - Publisher Copyright:
© 2015 American College of Cardiology Foundation.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Objectives The aim of this study was to describe contemporary frequency, predictors, and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in the United States. Background CTO PCI can provide significant clinical benefits, yet there is limited information on its success and safety in unselected patient populations. Methods We analyzed the frequency and outcomes of CTO PCI compared with non-CTO PCI in elective patients, and of successful versus failed CTO PCI between July 1, 2009, and March 31, 2013, in the National Cardiovascular Data Registry CathPCI Registry. Generalized estimating equations logistic regression modeling was used to generate independent variables associated with procedural success and procedural complications. Results During the study period, CTO PCI represented 3.8% of the total PCI volume for stable coronary artery disease (22,365 of 594,510). Overall, patients undergoing CTO PCI required greater contrast volume and longer fluoroscopy time and had lower procedural success (59% vs. 96%, p < 0.001) and higher major adverse cardiac event (1.6% vs. 0.8%, p < 0.001) rates than non-CTO PCI patients. On multivariable analysis, several parameters (including older age, current smoking, previous myocardial infarction, previous coronary artery bypass graft, previous peripheral arterial disease, previous cardiac arrest, right coronary artery CTO target vessel, and less operator experience) were associated with a lower likelihood of CTO PCI procedural success, whereas operators' annual CTO PCI volume was associated with improved success without a significant increase in major complications. Conclusions CTO PCI is currently performed infrequently in the United States for stable coronary artery disease and is associated with lower procedural success and higher complication rates compared with non-CTO PCI. Procedural success was associated with several patient factors and operator experience.
AB - Objectives The aim of this study was to describe contemporary frequency, predictors, and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in the United States. Background CTO PCI can provide significant clinical benefits, yet there is limited information on its success and safety in unselected patient populations. Methods We analyzed the frequency and outcomes of CTO PCI compared with non-CTO PCI in elective patients, and of successful versus failed CTO PCI between July 1, 2009, and March 31, 2013, in the National Cardiovascular Data Registry CathPCI Registry. Generalized estimating equations logistic regression modeling was used to generate independent variables associated with procedural success and procedural complications. Results During the study period, CTO PCI represented 3.8% of the total PCI volume for stable coronary artery disease (22,365 of 594,510). Overall, patients undergoing CTO PCI required greater contrast volume and longer fluoroscopy time and had lower procedural success (59% vs. 96%, p < 0.001) and higher major adverse cardiac event (1.6% vs. 0.8%, p < 0.001) rates than non-CTO PCI patients. On multivariable analysis, several parameters (including older age, current smoking, previous myocardial infarction, previous coronary artery bypass graft, previous peripheral arterial disease, previous cardiac arrest, right coronary artery CTO target vessel, and less operator experience) were associated with a lower likelihood of CTO PCI procedural success, whereas operators' annual CTO PCI volume was associated with improved success without a significant increase in major complications. Conclusions CTO PCI is currently performed infrequently in the United States for stable coronary artery disease and is associated with lower procedural success and higher complication rates compared with non-CTO PCI. Procedural success was associated with several patient factors and operator experience.
KW - chronic total occlusion
KW - complications outcomes
KW - percutaneous coronary intervention
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U2 - 10.1016/j.jcin.2014.08.014
DO - 10.1016/j.jcin.2014.08.014
M3 - Article
C2 - 25700746
AN - SCOPUS:84923168331
SN - 1936-8798
VL - 8
SP - 245
EP - 253
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 2
ER -