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Impact of Calcium on Chronic Total Occlusion Percutaneous Coronary Interventions

Judit Karacsonyi1, Dimitri Karmpaliotis2, Khaldoon Alaswad3

  • 1Department of Cardiology, Veterans Affairs North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.

The American Journal of Cardiology
|May 14, 2017
PubMed

Insights

Calcific deposits in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) increase procedure complexity and complication rates. However, moderate to severe calcium was not independently linked to lower technical success in this study.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Calcific deposits are common in coronary artery disease.
  • Chronic total occlusions (CTOs) present unique challenges for percutaneous coronary intervention (PCI).
  • The impact of lesion calcification on CTO PCI outcomes requires further investigation.

Purpose of the Study:

  • To evaluate the association between calcific deposits and outcomes in CTO PCI.
  • To identify factors influencing the success and complications of CTO PCI in calcified lesions.

Main Methods:

  • Retrospective analysis of 1,476 CTO PCI procedures from 11 US centers (2012-2016).
  • Assessment of moderate/severe calcification in 58% of target lesions.
  • Comparison of procedural characteristics, success rates, and major adverse cardiac events (MACE) between calcified and non-calcified CTOs.

Main Results:

  • Moderate/severe calcification was associated with more tortuous lesions, ambiguous proximal caps, and interventional collaterals.
  • PCI of calcified CTOs required more frequent retrograde approaches (54% vs 30%) and longer procedure times.
  • Calcified lesions showed lower technical (86.6% vs 93.8%) and procedural (84.4% vs 92.7%) success rates and higher MACE (3.7% vs 1.8%).

Conclusions:

  • Moderate to severe calcific deposits are prevalent in CTO PCI and linked to increased procedural complexity and adverse outcomes.
  • Despite associations with lower success and higher MACE, calcium presence was not an independent predictor of technical success on multivariate analysis.
  • Lesion preparation techniques included balloon angioplasty, rotational atherectomy, and laser for calcified CTOs.

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