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Percutaneous Coronary Interventions in Chronic Total Occlusion - Profile, Technique and Outcome - The Malabar
Desabandhu Vinayakumar1, Madhusudan Pramod Raikar1, Kurukkanparampil Sreedharan Mohanan1
1Department of Cardiology, Government Medical College, Kozhikode, Kerala 673008, India.
Insights
Percutaneous coronary intervention for chronic total occlusion (CTO-PCI) achieved over 80% success. Unsuccessful CTO-PCI significantly increased major adverse cardiac events and residual symptoms like angina and dyspnea.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) presents significant challenges compared to non-CTO PCI.
- Higher complexity, radiation exposure, contrast load, and complication risks are associated with CTO procedures.
- Limited data exists on long-term clinical outcomes of CTO-PCI in the Indian subcontinent.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of elective percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).
- To assess procedural success rates, complications, and major adverse cardiac events (MACE) in a real-world cohort.
- To provide data justifying investments in CTO-PCI training and technology.
Main Methods:
- A prospective observational study involving 339 consecutive patients undergoing elective PCI for CTO.
- Follow-up ranged from 3 to 36 months (median 24 months).
- Assessment of procedural techniques, in-hospital adverse events, MACE, target vessel revascularization (TVR), all-cause death, cardiac death, residual angina, and dyspnea.
Main Results:
- Overall procedural success rate was 85.5%.
- No significant difference in in-hospital adverse events between successful and unsuccessful procedures.
- Higher MACE rates (36.7% vs. 8.9%) and significantly worse residual angina (26.5% vs. 10%) and dyspnea (34.7% vs. 12.4%) in the unsuccessful CTO group.
Conclusions:
- Procedural success for CTO-PCI in the drug-eluting stent (DES) era exceeds 80%, with improved outcomes in younger patients due to newer techniques and hardware.
- Unsuccessful CTO-PCI is associated with significantly higher MACE rates.
- Patients with unsuccessful CTO-PCI experience worse residual angina and dyspnea.
Introduction:
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) remains a challenge. The reasons being that these procedures may be lengthy and complex, with elevated radiation exposure, increased contrast load, lower procedural success rate, and a higher risk of complication when compared with non-CTO elective PCI.Clarifying the long-term clinical outcomes of CTO-PCI is very important to justify potential investments in training and technology. However, there is a paucity of data from Indian subcontinent. Hence we decided to report the outcomes from a real-life cohort of consecutive patients undergoing elective PCI for CTO at our institution.
Materials And Methods:
Single-center, prospective observational study. A total of 339 consecutive patients who underwent elective PCI for chronic total occlusion between Feb 2016 to Feb 2018 were included in the study. Procedural techniques, complications and clinical outcomes {all-cause death, cardiac death, major adverse cardiac events (MACE) and target vessel revascularization (TVR)} were assessed in our study population.
Results:
339 patients were prospectively followed up for a duration that ranged from 3 months to 36 months, with a median follow up of 24 months. Overall procedural success was achieved in 85.5% (n = 290) cases. No significant differences were noted in In-Hospital adverse events (5.5% vs. 4.1%; p 0.998). MACE rate was significantly higher in unsuccessful CTO group (36.7% vs. 8.9%, p 0.001) and was predominantly driven by Ischemia Driven (ID) - Revascularization (16.3% vs. 3.1%, p < 0.001). Cardiac death and All-cause death was not significantly different between the groups. Residual angina (26.5% vs. 10%, p 0.003) and residual dyspnoea (34.7% vs. 12.4%, p < 0.001) were significantly worse in unsuccessful CTO group.
Conclusions:
Procedural success in the present drug-eluting stent (DES) era is more than 80% and newer techniques and hardwares have improved the procedural success rate, especially in younger age groups. MACE rates were significantly higher in the unsuccessful CTO group. Residual angina and dyspnoea were significantly worse in the unsuccessful CTO group.
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