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Outcomes of retrograde chronic total occlusion percutaneous coronary intervention: A report from the OPEN-CTO
Sanjog Kalra1, Darshan Doshi2, James Sapontis3
1Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania.
Insights
Retrograde percutaneous coronary intervention for chronic total occlusion (CTO PCI) had higher in-hospital risks but similar long-term quality of life outcomes compared to antegrade-only approaches.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Outcomes of retrograde versus antegrade-only percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) are not well-established.
- CTO PCI is a complex procedure with varying technical approaches.
Purpose of the Study:
- To compare in-hospital and long-term clinical outcomes of retrograde versus antegrade-only CTO PCI.
- To evaluate the impact of different CTO PCI techniques on patient quality of life.
Main Methods:
- Analysis of the OPEN-CTO registry, including 885 single CTO procedures.
- Comparison of retrograde (n=454) versus antegrade-only (n=431) CTO PCI.
- Primary endpoints: in-hospital and 1-year major adverse cardiac and cerebrovascular events (MACCE), and quality of life scores.
Main Results:
- Retrograde CTO PCI involved more complex lesions and had lower technical success rates.
- In-hospital MACCE rates were significantly higher in the retrograde group (10.8% vs. 3.3%).
- One-year MACCE rates were also higher in the retrograde group (19.5% vs. 13.9%), but sensitivity analyses showed no difference post-discharge.
- Quality of life improvements were similar between both groups at 1-year.
Conclusions:
- Retrograde CTO PCI is associated with increased in-hospital MACCE compared to antegrade-only PCI.
- Despite higher initial risks, retrograde and antegrade-only CTO PCI yield similar long-term clinical outcomes and quality of life improvements.
- Technical modality choice should consider lesion complexity and patient-specific factors.
Objectives:
We sought to assess in-hospital and long-term outcomes of retrograde compared with antegrade-only percutaneous coronary intervention for chronic total occlusion (CTO PCI).
Background:
Procedural and clinical outcomes following retrograde compared with antegrade-only CTO PCI remain unknown.
Methods:
Using the core-lab adjudicated OPEN-CTO registry, we compared the outcomes of retrograde to antegrade-only CTO PCI. Primary endpoints included were in-hospital major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, stroke, myocardial infarction [MI], emergency cardiac surgery, or clinically significant perforation) and MACCE at 1-year (all-cause death, MI, stroke, target lesion revascularization, or target vessel reocclusion).
Results:
Among 885 single CTO procedures from the OPEN-CTO registry, 454 were retrograde and 431 were antegrade-only. Lesion complexity was higher (J-CTO score: 2.7 vs. 1.9; p < .001) and technical success lower (82.4 vs. 94.2%; p < .001) in retrograde compared with antegrade-only procedures. All-cause death was higher in the retrograde group in-hospital (2 vs. 0%; p = .003), but not at 1-year (4.9 vs. 3.3%; p = .29). Compared with antegrade-only procedures, in-hospital MACCE rates (composite of all-cause death, stroke, MI, emergency cardiac surgery, and clinically significant perforation) were higher in the retrograde group (10.8 vs. 3.3%; p < .001) and at 1-year (19.5 vs. 13.9%; p = .03). In sensitivity analyses landmarked at discharge, there was no difference in MACCE rates at 1 year following retrograde versus antegrade-only CTO PCI. Improvements in Seattle Angina Questionnaire Quality of Life scores at 1-year were similar between the retrograde and antegrade-only groups (29.9 vs 30.4; p = .58).
Conclusions:
In the OPEN-CTO registry, retrograde CTO procedures were associated with higher rates of in-hospital MACCE compared with antegrade-only; however, post-discharge outcomes, including quality of life improvements, were similar between technical modalities.
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