[Determinants of success percutaneous coronary intervention in patients with chronic total coronary artery occlusion]
Chen-guang Li1, Xue-bo Liu, Lei Ge
1Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China.
Insights
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is safe and effective, with an 85.5% success rate. Key factors influencing PCI success include patient age and specific lesion characteristics like calcification and tortuosity.
Area of Science:
- Interventional Cardiology
- Cardiovascular Disease Research
- Vascular Interventions
Context:
- Chronic total occlusion (CTO) represents a significant challenge in coronary artery disease management.
- Contemporary percutaneous coronary intervention (PCI) techniques aim to improve outcomes for CTO patients.
- Understanding determinants of procedural success is crucial for optimizing CTO treatment strategies.
Purpose:
- To assess the in-hospital outcomes of PCI in patients with CTO.
- To identify clinical and angiographic factors associated with PCI success rates in CTO.
- To evaluate the safety and efficacy of modern PCI approaches for CTO.
Summary:
- This retrospective analysis of 1485 CTO patients (447 undergoing PCI) found an 85.5% procedural success rate.
- Complications included coronary perforation (6.0%) and cardiac tamponade (2.2% of perforations).
- Factors predicting procedural failure included advanced patient age, excessive calcification, tortuosity, and absence of a proximal stump.
Impact:
- PCI is a safe and effective treatment for CTO, with significant success rates.
- Procedural success is strongly correlated with the specific clinical and angiographic features of the CTO lesion.
- These findings can guide interventional cardiologists in patient selection and procedural planning for CTO interventions.
Objective:
To evaluate the in-hospital outcome and determinants relating to success rate of percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) using contemporary techniques.
Methods:
A total of 1485 patients with total occluded coronary artery were identified from January 2004 to December 2008 in Zhongshan hospital. Of them, 638 patients were affirmed as CTO and 447 patients underwent PCI. The clinical data and the in-hospital outcome of patients underwent PCI were retrospectively analyzed.
Results:
Procedure success was achieved in 382 patients (85.5%). Coronary perforation (C-F type dissection or coronary perforation) occurred in 27 patients (6.0%), cardiac tamponade developed in 6 out of the 27 patients, 2 patients (0.4%) received in-hospital repeat revascularization. Two patients (0.4%) died post PCI: one died of acute stent thrombosis and the other one died of refractory heart and respiratory failure.Compared with patients of successful recanalization, patients failure to recanalization were more aged [(62.9 ± 10.4)years vs. (65.9 ± 9.9) years, P < 0.05] and excessive tortuosity (16.2% vs. 38.5%, P < 0.01), absence stump (47.1% vs. 80.0%, P < 0.01) and excessive calcification (36.9% vs. 72.3%, P < 0.01) were more common. Multiple logistic regression analysis revealed that excessive calcification (OR: 3.866, P < 0.01), absence stump (OR: 3.346, P < 0.05) and excessive tortuosity (OR: 3.055, P < 0.01) were independent predictors for the procedural failure.
Conclusions:
PCI for patients with CTO is safe and effective. Apart from progress on the equipment development, procedural success rates are closely related with the clinical and angiographic features of CTO.
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