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Differences in patients and lesion and procedure characteristics depending on the age of the coronary chronic total
Krzysztof L Bryniarski1, Gerald S Werner2, Kambis Mashayekhi3
1Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, the John Paul II Hospital, Krakow, Poland.
Insights
Longer chronic total occlusion (CTO) duration is linked to more complex lesions, including calcification and longer length. This duration also significantly reduces the success rate of percutaneous coronary intervention for CTO.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- The impact of chronic total occlusion (CTO) duration on lesion characteristics and revascularization outcomes is not well understood.
- Understanding these relationships is crucial for optimizing treatment strategies.
Purpose of the Study:
- To investigate the influence of CTO duration on lesion morphology and percutaneous coronary intervention (PCI) success.
- To identify factors associated with CTO duration and procedural outcomes.
Main Methods:
- Analysis of EuroCTO Registry data from January 2015 to April 2017.
- Patients were categorized into three groups based on occlusion duration: 3-6 months, 7-12 months, and >12 months.
- Multivariate analysis was employed to assess associations between CTO duration and clinical/lesion characteristics.
Main Results:
- Increased CTO duration correlated with older patient age, higher prevalence of 3-vessel disease, and more frequent prior coronary artery bypass grafting.
- Longer occlusion duration was significantly associated with moderate/severe calcification, lesion length >20 mm, and collateral circulation (Werner type 2).
- CTO duration was inversely associated with procedural success (OR 0.60; 95% CI: 0.46-0.79; p < 0.001).
Conclusions:
- Coronary artery CTO duration is a significant factor influencing lesion complexity, including calcification and length.
- Longer CTO duration is independently associated with reduced procedural success in PCI.
- In-hospital adverse events did not significantly differ based on CTO duration.
Introduction:
Whether duration of chronic total occlusion (CTO) affects lesion and procedural characteristics remains largely unknown.
Aim:
To investigate whether CTO duration influences lesion characteristics and revascularization success.
Material And Methods:
EuroCTO Registry data on patients who had CTO percutaneous coronary intervention between January 2015 and April 2017 were analyzed. Three groups were created based on occlusion age: 3 to 6 months (n = 1415), 7 to 12 months (n = 973), > 12 months (n = 1656).
Results:
Patients with greater CTO duration were older (63.0 (56.0-70.0); 63.0 (56.0-71.0); 66.0 (59.0-73.0) years respectively; p < 0.001), had more 3-vessel disease (32.2%; 30.9%; 46.1% respectively; p < 0.001) and more frequent prior coronary artery bypass grafting (8.2%; 9.9%; 29.4% respectively; p < 0.001). In multivariate analysis, occlusion duration was associated with moderate/severe calcification (OR = 1.52; 95% CI: 1.28-1.80; p < 0.001), lesion length > 20 mm (OR 1.77; 95% CI 1.49-2.10; p < 0.001), and collateral circulation Werner type 2 (OR = 1.20; 95% CI: 1.01-1.43; p = 0.041). The CTO duration was associated with lower procedural success (OR for success 0.60; 95% CI: 0.46-0.79; p < 0.001). In multivariate analysis in-hospital adverse events did not differ according to duration of CTO.
Conclusions:
Coronary artery CTO duration is associated with greater extent of calcification, lesion length, development of collateral circulation and, most importantly, with lower procedural success.
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