Real world perspective of coronary chronic total occlusion in third world countries: A tertiary care centre study
Krishna Santosh Vemuri1, Bhupinder Kumar Sihag1, Yashpaul Sharma1
1Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh, 160012, India.
Insights
Coronary chronic total occlusions (CTO) are common in Indian patients. Percutaneous coronary intervention (PCI) for CTOs shows a fair success rate in experienced centers, with age and lesion complexity predicting outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Limited data exists on the prevalence and outcomes of percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) in India.
- This study addresses the gap by analyzing CTO characteristics and PCI outcomes in a North Indian tertiary referral center.
Purpose of the Study:
- To determine the prevalence, clinical features, angiographic profile, and outcome predictors of PCI for CTOs.
- To evaluate the success rates and factors influencing outcomes of CTO PCI in a specific Indian population.
Main Methods:
- Retrospective analysis of 12,020 patients undergoing coronary angiography (CAG) from January 2018 to January 2019.
- Collected detailed clinical, angiographic, and revascularization data, focusing on CTO identification and PCI outcomes.
- Analyzed baseline parameters to identify predictors of CTO PCI success and complications.
Main Results:
- CTO prevalence was 16.3% among all CAG patients and 24.4% in those with significant coronary artery disease (CAD).
- The left anterior descending (LAD) artery was most commonly affected (48%), followed by the right coronary artery (RCA) (42.9%).
- PCI success rate was 74.6% in 456 attempted CTOs. Increasing age, male sex, CTO in the left circumflex (LCx) artery, and higher J-CTO scores predicted poorer outcomes.
Conclusions:
- Coronary chronic total occlusions are frequently encountered during coronary angiography.
- Percutaneous coronary intervention for CTOs can achieve a fair success rate in high-volume, experienced centers, though outcomes are influenced by patient and lesion-specific factors.
Objectives:
The aim of this study is to determine the prevalence, clinical characteristics, angiographic profile and predictors of outcome for percutaneous coronary interventions (PCI) of coronary chronic total occlusions (CTO) in a tertiary referral centre of north India.
Background:
There is no data on the prevalence and very few reports on clinical characteristics, angiographic profile and outcome of PCI in CTO from India.
Methods:
Retrospective analysis was done for the data of 12,020 patients undergoing coronary angiography (CAG) between January 2018 to January 2019 at our centre. Detailed baseline clinical, angiographic and revascularization data was collected. Outcome of CTO PCI was also noted. All baseline parameters were analysed for predicting the outcome of CTO PCI.
Results:
CTO was identified in 16.3% (1968) patients undergoing CAG and in 24.4% of patients with hemodynamically significant CAD. CTO was predominantly found in LAD (48%) followed by RCA (42.9%) and LCx (25.3%) arterial distribution. Mean JCTO score was 1.93 ± 0.7. PCI as a management strategy was adopted in 456 of 1968 patients (23.1%) and was successful in 340 of 456 (74.6%) of patients. Almost all CTO PCI were attempted by an antegrade approach only. Increasing age, male sex, CTO in LCx arterial distribution and higher J CTO score were associated with poorer outcome in CTO PCI.
Conclusions:
CTO's are commonly encountered during CAG procedures. In patients undergoing CTO PCI, a fair success rate can be achieved in a high volume experienced centre.
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