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Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Interventions: Characteristics, Success, and
Edward L Hannan1, Ye Zhong2, Alice K Jacobs2
1From the Department of Health Policy, Management, and Behavior, University at Albany, State University of New York (E.L.H., Y.Z.); Department of Cardiology, Boston Medical Center, MA (A.K.J.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Department of Cardiology, Northwell Health, Danville, PA (P.B.B.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (G.W.); Department of Cardiology, Mt Sinai Medical Center, New York, NY (S.S.); Department of Cardiology, Albany Medical Center, NY (F.J.V.); and Department of Cardiology, St Joseph's Health System, Atlanta, GA (S.B.K.). elh03@health.state.ny.us.
Insights
Percutaneous coronary intervention for chronic total occlusions (CTO PCI) shows a low success rate but improves survival. Higher volume operators achieve better outcomes in CTO PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is recognized as a valuable treatment.
- Limited data exists on the real-world application and outcomes of CTO PCI.
Purpose of the Study:
- To analyze the utilization patterns of CTO PCI in routine practice.
- To evaluate success rates, factors influencing success, and patient mortality associated with CTO PCI.
Main Methods:
- Retrospective analysis of data from New York's PCI registry (July 2009 - June 2012).
- Inclusion of 4030 patients who underwent CTO PCI.
- Examination of operator volume, patient characteristics, and 2.5-year mortality.
Main Results:
- A success rate of 61.3% was observed for CTO PCI.
- Successful CTO PCI was associated with younger patients, higher ejection fractions, and fewer comorbidities.
- Operators performing ≥48 CTO PCIs annually had over double the odds of success compared to low-volume operators (<9/year).
- Unsuccessful CTO PCI correlated with significantly higher 2.5-year mortality.
Conclusions:
- CTO PCI has a lower success rate compared to other coronary lesions.
- Successful CTO revascularization is linked to improved patient survival.
- Higher operator volume in CTO PCI procedures is associated with increased success rates.
Background:
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) has been identified as a beneficial treatment, but there is limited information about its use in everyday practice.
Methods And Results:
Data from New York's PCI registry between July 1, 2009, and June 30, 2012, were used to examine the utilization and variation in use of CTO PCI, the success rates across providers, the multivariable correlates of success, and the mortality of successful CTO PCI. A total of 4030 (3.1%) patients undergoing PCI underwent CTO PCI with a success rate of 61.3%. Patients with successful CTO PCIs were younger; had higher ejection fractions; were less likely to have had previous revascularization or carotid/cerebrovascular disease; and were more likely to have the CTO in the left anterior descending artery. Operators with annual CTO PCI volumes of at least 48 per year (the top volume quartile) had odds of achieving success that were more than twice as high as the half of all operators who performed <9 CTO PCIs per year. Patients with unsuccessful CTO PCIs had significantly higher 2.5-year mortality (adjusted hazard ratio, 1.63; 95% confidence interval, 1.28-2.08) than patients who had complete revascularization (CR) for all CTOs and other diseased lesions.
Conclusions:
The success rate for CTO is low compared with the rate for other lesions. Successful revascularization of CTO is associated with improved survival compared with procedures with unsuccessful CTO, and higher-volume CTO operators are more successful.
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