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Published on: March 27, 2018
In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary
Peter Tajti1,2, Dimitri Karmpaliotis3, Khaldoon Alaswad4
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.T., M.N.B., I.X., L.I.S., B.V.R., E.S.B.).
Insights
Patients with prior coronary artery bypass graft surgery undergoing chronic total occlusion interventions had lower success rates but similar complication risks. However, mortality was higher, while tamponade incidence was lower in this group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) are complex procedures.
- Patients with prior coronary artery bypass graft surgery (CABG) present unique challenges for CTO PCI.
Purpose of the Study:
- To evaluate the procedural outcomes of CTO PCI in patients with prior CABG.
- To compare clinical and angiographic characteristics and outcomes between patients with and without prior CABG undergoing CTO PCI.
Main Methods:
- A large multicenter registry of 3486 CTO interventions was analyzed.
- Patients were stratified into two groups: those with prior CABG (n=1101) and those without (n=2317).
- Clinical data, angiographic characteristics, procedural techniques, and in-hospital outcomes were compared.
Main Results:
- Prior CABG patients were older, had more comorbidities, and lower ejection fraction.
- Higher J-CTO and PROGRESS-CTO scores were observed in the prior CABG group, indicating greater lesion complexity.
- Retrograde and antegrade dissection reentry techniques were used more frequently in prior CABG patients.
- Technical and procedural success rates were lower in prior CABG patients (84% and 82%, respectively) compared to those without (89% and 87%).
- In-hospital mortality (1% vs 0.4%) and coronary perforation (7.1% vs 3.1%) were higher in prior CABG patients.
- Incidence of pericardial tamponade (0.1% vs 1.0%) and pericardiocentesis (0% vs 1.3%) was lower in prior CABG patients, despite similar overall major complication rates (3.1% vs 2.5%).
Conclusions:
- Prior CABG patients undergoing CTO PCI experience lower procedural success rates.
- While overall in-hospital complication risks are similar, mortality is higher in prior CABG patients.
- Specific complications like tamponade are less frequent in prior CABG patients, suggesting differences in procedural management or patient factors.
Background:
We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG).
Methods And Results:
We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32% of total cohort) were older (67±9 versus 63±10 years; P<0.001) and had more comorbidities and lower left ventricular ejection fraction (50% [40-58] versus 55% [45-60]; P<0.001). The CTO target vessel in prior CABG patients was the right coronary artery (56%), circumflex (26%), and left anterior descending artery (17%). The mean J-CTO (2.9±1.2 versus 2.2±1.3; P<0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; 1.5±1.1 versus 1.2±1.0; P<0.001) score was higher in prior CABG patients. Retrograde (53% versus 30%, P<0.001) and antegrade dissection reentry (35% versus 28%; P<0.001) techniques were used more frequently in prior CABG patients. Prior CABG patients had lower technical (84% versus 89%; P<0.001) and procedural (82% versus 87%, P<0.001) success, but similar incidence of in-hospital major complications (3.1% versus 2.5%; P=0.287). In-hospital mortality (1% versus 0.4%; P=0.016) and coronary perforation (7.1% versus 3.1%; P<0.001) occurred more frequently in prior CABG patients, however, CABG patients had a lower incidence of pericardial tamponade (0.1% versus 1.0%; P=0.002) and pericardiocentesis (0% versus 1.3%; P<0.001).
Conclusions:
In a large multicenter CTO percutaneous coronary interventions registry, prior CABG patients had lower success rate but similar overall risk for complications, although mortality was higher and the incidence of tamponade was lower.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov . Unique identifier: NCT02061436.
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