Echocardiography vs hemodynamic assessment of diastolic dysfunction

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Ostial chronic total occlusions (CTOs) represent a complex subset of coronary artery disease.
• Revascularization of these lesions via percutaneous coronary intervention (PCI) can be technically demanding.

Purpose of the Study:

• To evaluate the clinical and procedural outcomes of ostial CTO PCI.
• To compare these outcomes with non-ostial CTO PCI.

Main Methods:

• A retrospective analysis of 8788 CTO PCI procedures performed between 2012 and 2022 across 35 international centers.
• In-hospital major adverse cardiac events (MACE) were defined as death, myocardial infarction, urgent repeat target-vessel revascularization, tamponade, and stroke.

Main Results:

• Ostial CTOs accounted for 12% of all CTOs and were associated with higher J-CTO scores.
• Ostial CTO PCI demonstrated lower technical (82% vs. 86%) and procedural (81% vs. 85%) success rates.
• Higher rates of in-hospital death (0.9% vs. 0.3%) and stroke (0.5% vs. 0.1%) were observed in ostial CTO PCI, alongside increased use of retrograde techniques, longer procedure times, and higher radiation doses.

Conclusions:

• Ostial CTOs are characterized by increased complexity, leading to reduced success rates in PCI.
• PCI for ostial CTOs requires more frequent retrograde approaches and is linked to higher risks of mortality and stroke, prolonged procedures, and greater radiation exposure.