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Chronic total occlusion percutaneous coronary intervention in Latin America
Alexandre Quadros1,2, Karlyse C Belli1, João E T de Paula3
1Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.
Insights
Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in Latin America show over 80% success. Key predictors of unsuccessful CTO PCI include calcification and blunt caps, with low major adverse cardiovascular events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) are increasingly common globally.
- Limited data exists on CTO PCI outcomes and characteristics in Latin America.
Purpose of the Study:
- To detail clinical and angiographic features of CTO PCI in Latin America.
- To report procedural outcomes and identify predictors of unsuccessful CTO PCI.
- To provide regional insights into CTO PCI practices.
Main Methods:
- An international multicenter registry collected data from 1,040 CTO PCIs across seven Latin American countries.
- Patient demographics, angiographic details, procedural techniques, and outcomes were evaluated.
- Multivariable analysis identified independent predictors of unsuccessful procedures.
Main Results:
- The study included 1,040 CTO PCIs, primarily for angina control (81%) or large ischemic areas (30%).
- Overall technical success rate was 82.5%, utilizing antegrade wire escalation (81%), antegrade dissection/re-entry (8%), and retrograde techniques (11%).
- Moderate/severe calcification, blunt proximal cap, and prior attempts predicted unsuccessful procedures. In-hospital MACE was 3.1%.
Conclusions:
- CTO PCI in Latin America is predominantly performed for ischemia relief.
- Procedures demonstrate high success rates (>80%) with a low incidence of major adverse cardiovascular events.
- Identified predictors of unsuccessful CTO PCI align with previously reported international findings.
Objectives:
To report clinical, angiographic characteristics, outcomes, and predictors of unsuccessful procedures in patients who underwent chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in Latin America.
Background:
CTO PCI has been increasingly performed worldwide, but there is a lack of information in this region.
Methods:
An international multicenter registry was developed to collect data on CTO PCI performed in centers in Latin America. Patient, angiographic, procedural and outcome data were evaluated. Predictors of unsuccessful procedures were assessed by multivariable analysis.
Results:
We have included data related to 1,040 CTO PCIs performed in seven countries in Latin America (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, and Puerto Rico). The mean age was 64 ± 10 years, and CTO PCI was performed mainly for angina control (81%) or treatment of a large ischemic area (30%). Overall technical success rate was 82.5%, and it was achieved with antegrade wire escalation in 81%, antegrade dissection/re-entry in 8% and with retrograde techniques in 11% of the successful procedures. Multivariable analysis identified moderate/severe calcification, a blunt proximal cap and a previous attempt as independent predictors of unsuccessful procedures. In-hospital major adverse cardiovascular events (MACE) occurred in 3.1% of the cases, death in 1% and cardiac tamponade in 0.9% CONCLUSIONS: CTO PCI in Latin America has been performed mainly for ischemia relief. Procedures were associated with a success rate above 80% and low incidence of MACE. Predictors of unsuccessful procedures were similar to those previously reported in the literature.
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