Impact of target vessel on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary...

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Vascular Medicine

Background:

• Limited data exists on how the target vessel influences chronic total occlusion (CTO) percutaneous coronary intervention (PCI) techniques and outcomes.
• Understanding these differences is crucial for optimizing CTO PCI strategies.

Purpose of the Study:

• To investigate the impact of the target coronary artery on the procedural success and safety of CTO PCI.
• To compare technical success rates and major adverse cardiovascular events (MACE) across different target vessels (right coronary artery, left anterior descending artery, left circumflex artery).

Main Methods:

• Analysis of 11,580 CTO PCI cases performed between 2012 and 2022 across 44 centers.
• Evaluation of baseline clinical and angiographic characteristics, procedural techniques, and outcomes.
• Comparison of technical success and MACE rates stratified by target vessel and lesion location.

Main Results:

• The right coronary artery (RCA) was the most common target (53.1%), followed by the left anterior descending artery (LAD) (26.0%) and left circumflex artery (LCX) (19.8%).
• RCA CTOs exhibited greater length and complexity (higher Japanese CTO score).
• Technical success was highest for LAD CTOs (88.8%) compared to RCA (85.7%) and LCX (85.8%). Distal RCA and non-marginal LCX lesions also showed higher success.
• Overall MACE incidence was 1.9%, with no significant difference among target vessels or lesion locations.

Conclusions:

• CTO PCI in the LAD artery is associated with superior technical and procedural success rates compared to other target vessels.
• The incidence of MACE is comparable across different target coronary arteries and their specific locations within CTOs.