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Angiography and Percutaneous Coronary Intervention for Chronic Total Coronary Occlusion in Daily Practice (from a
Madjid Boukantar1, Aurélie Loyeau2, Romain Gallet1
1Interventional Cardiology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, France.
Insights
Chronic total occlusion (CTO) affects over 8% of patients undergoing coronary angiography. While CTOs are more common in patients with risk factors and multivessel disease, percutaneous coronary intervention (PCI) success rates are not linked to procedural volume.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Chronic total occlusion (CTO) is a complex coronary lesion.
- Understanding CTO prevalence and management is crucial for daily cath lab practice.
Purpose of the Study:
- To determine the contemporary prevalence and management of CTO in a large, unselected population.
- To compare percutaneous coronary intervention (PCI) characteristics in patients with and without CTO.
Main Methods:
- Analysis of the CARDIO-ARSIF registry data (2012-2015) for 128,739 patients.
- Exclusion of patients with acute coronary syndrome or prior coronary artery bypass grafting.
- Comparison of PCI procedures in patients with and without CTO.
Main Results:
- 8.1% of patients had at least one CTO.
- CTO patients had higher cardiovascular risk factors and multivessel disease (74% vs 24%).
- CTO-PCI constituted 5.7% of all PCIs, increasing over time, with a 75.9% success rate unrelated to center volume.
Conclusions:
- CTO is a frequent finding in patients undergoing elective coronary angiography.
- Patients with CTO are more likely to receive invasive management.
- CTO-PCI success is not dependent on the volume of procedures performed per center.
Abstract:
The aim of this study was to provide contemporary data on chronic total occlusion (CTO) prevalence and management in a large unselected population representing the daily activity of cathlabs, in the greater Paris area, and to compare percutaneous coronary intervention (PCI) features in patients with and without CTO. Procedures were collected from the CARDIO-ARSIF (Agence Régionale de Santé Ile de France) registry from 2012 to 2015. Patients with acute coronary syndrome or previous coronary artery bypass grafting were excluded. CTO features were assessed and PCIs with and without CTO were compared. Among 128,739 included patients, 10,468 (8.1%) had at least 1 CTO. Cardiovascular risk-factor burden was higher in the CTO group, which had more patients with multivessel disease (74% vs 24%) and with referral for interventional management (59% vs 33%). Of all PCIs during the study period, 5.7% involved a CTO; this proportion increased significantly over the study period. PCI success rate was 75.9% in the CTO group. CTO-PCI volume per center did not correlate with CTO-PCI success rate. In conclusion, CTO is common in patients who underwent scheduled coronary angiography. Invasive management is done more often in patients with than without CTO. The success rate of PCI in CTO is not associated with case volume per center.
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