Long-term outcomes of successful chronic total occlusion percutaneous coronary interventions using the antegrade and
Tesfaldet T Michael1, Owen Mogabgab, Mohammed Alomar
1Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
Insights
The retrograde approach for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) showed a higher need for target lesion revascularization (TLR) but similar rates of death and heart attack compared to the antegrade approach.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Limited long-term clinical outcomes data exists for the retrograde approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- Understanding the comparative effectiveness of retrograde versus antegrade CTO PCI is crucial for optimizing patient care.
Purpose of the Study:
- To compare the long-term clinical outcomes of CTO PCI utilizing retrograde and antegrade approaches.
- To evaluate differences in target lesion revascularization (TLR), mortality, and myocardial infarction between the two techniques.
Main Methods:
- Retrospective analysis of 193 patients undergoing successful CTO PCI between March 2008 and December 2011.
- Comparison of clinical outcomes between patients treated with retrograde (n=41) and antegrade approaches.
- Median follow-up of 2.0 years to assess long-term results.
Main Results:
- The retrograde CTO PCI group required longer stent lengths (83±32 vs. 64±32 mm) and experienced more procedural complications (P=0.012).
- Retrograde CTO PCI was associated with a significantly higher incidence of target lesion revascularization (TLR) (45.6% vs. 25.7%, P=0.006).
- No significant differences were observed in all-cause mortality or myocardial infarction between the groups.
Conclusions:
- Retrograde CTO PCI is linked to an increased risk of TLR but comparable rates of death and myocardial infarction versus the antegrade approach.
- The higher complexity of lesions treated with the retrograde technique may explain the observed differences in TLR.
Objective:
To compare long-term clinical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using the retrograde and antegrade approach.
Background:
There is limited long-term clinical outcomes data on the retrograde approach to CTO PCI.
Methods:
We performed a retrospective analysis of the long-term clinical outcomes of 193 consecutive patients who underwent successful CTO PCI at our institution between March 2008 and December 2011.
Results:
Mean age was 63.6 ± 8.3 years. The target vessel was right coronary artery in 52.6%, left anterior descending artery in 24.5% and circumflex in 21.4% of cases. The retrograde approach was used in 41 patients (21.2%). The mean stent length was longer in the retrograde group (83 ± 32 vs. 64 ± 32 mm, P = 0.001). Two major procedural complications occurred, both in the retrograde group (P = 0.012). During a median follow-up of 2.0 years compared to the antegrade CTO PCI group, patients who underwent retrograde CTO PCI were more likely to undergo target lesion revascularization (TLR) (45.6% vs. 25.7%, P = 0.006). No significant difference was observed in the incidence of all-cause mortality, myocardial infarction, non-target vessel revascularization, or coronary artery bypass graft surgery between the 2 groups. On multivariate analysis, stent length was the only independent predictor of TLR during follow-up.
Conclusions:
Retrograde CTO PCI was associated with higher incidence of TLR, but similar incidence of death and myocardial infarction compared to antegrade CTO PCI. These findings likely reflect the higher complexity of CTO lesions treated with the retrograde approach.
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