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Periprocedural Mortality in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the
Bahadir Simsek1, Athanasios Rempakos1, Spyridon Kostantinis1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (B.S., A.R., S.K., J.K., O.C.M., B.V.R., S.S.A., Y.S., M.N.B., E.S.B.).
Insights
Death is a rare complication of chronic total occlusion (CTO) percutaneous coronary intervention. The PROGRESS-CTO registry found that 0.4% of patients died, with tamponade being the leading cause, highlighting the need for risk stratification.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with rare but serious complications.
- Patient mortality during the index hospitalization for CTO PCI is a critical outcome to understand.
Purpose of the Study:
- To investigate the clinical characteristics and procedural outcomes of patients who experienced periprocedural death during CTO PCI.
- To identify risk factors and causes of mortality in this patient cohort.
Main Methods:
- Analysis of data from the Prospective Global Registry for the Study of CTO Interventions (PROGRESS-CTO).
- Comparison of clinical and procedural factors between patients who died and those who survived CTO PCI.
- Evaluation of specific scoring systems (J-CTO, PROGRESS-CTO mortality and pericardiocentesis) and procedural strategies.
Main Results:
- 52 out of 12,928 patients (0.4%) died during index hospitalization for CTO PCI.
- Patients who died were more likely to have a history of heart failure and higher J-CTO, PROGRESS-CTO mortality, and pericardiocentesis scores.
- Cardiac causes predominated, with cardiac tamponade (58%) being the most frequent cause of death, followed by acute myocardial infarction and cardiac arrest.
Conclusions:
- Mortality following CTO PCI is low (0.4%), but significant.
- Higher complication scores and specific patient characteristics are associated with increased risk of death.
- The PROGRESS-CTO complication scores may aid in risk stratification and procedural planning for CTO PCI.
Background:
Death is a rare but devastating complication of chronic total occlusion (CTO) percutaneous coronary intervention.
Methods:
We examined the clinical characteristics and procedural outcomes of patients who died periprocedurally in the Prospective Global Registry for the Study of CTO Interventions (PROGRESS-CTO).
Results:
Of the 12 928 patients who underwent CTO percutaneous coronary intervention between 2012 and 2022, 52 (0.4%) died during the index hospitalization. Patients who died were more likely to have a history of heart failure (43% versus 28%; P=0.023). The J-CTO ([Multicenter CTO Registry of Japan]; 2.8±1.1 versus 2.4±1.3; P=0.019), PROGRESS-CTO mortality (2.6±0.9 versus 1.6±1.1; P<0.001), and PROGRESS-CTO pericardiocentesis (2.9±1.1 versus 1.9±1.3; P<0.001) scores were higher in patients who died. In these patients, the use of left ventricular assist devices was also higher (41% versus 3.5%; P<0.001), and retrograde crossing was more often the first crossing strategy (33% versus 13%; P<0.001). The cause of death was cardiac in 43 patients (83%) and noncardiac in 9 patients (17%). Complications leading to cardiac death were: tamponade in 30 patients (58%), acute myocardial infarction in 9 (17.3%), and cardiac arrest/shock in 4 (7.7%). Noncardiac causes of death were: stroke in 3 (5.8%), renal failure in 2 (3.8%), respiratory distress in 2 (3.8%), and hemorrhagic shock in 2 (3.8%).
Conclusions:
Approximately 0.4% of patients who underwent CTO percutaneous coronary intervention died during the index hospitalization. The main cause of death was tamponade in 58%. PROGRESS-CTO complication scores might help in risk stratification and procedural planning in patients undergoing CTO percutaneous coronary intervention.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique Identifier: NCT02061436.
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