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Predictors of successful primary antegrade wiring in chronic total occlusion percutaneous coronary intervention
Athanasios Rempakos1, Michaella Alexandrou1, Deniz Mutlu1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
Antegrade wiring is a common strategy for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Several factors influence the success of this antegrade wiring approach in CTO PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Antegrade wiring is the predominant technique for crossing chronic total occlusions (CTOs).
- Understanding factors influencing its success is crucial for optimizing percutaneous coronary interventions (PCIs).
Purpose of the Study:
- To evaluate the clinical and angiographic characteristics and procedural outcomes of CTO PCIs using a primary antegrade wiring strategy.
- To identify predictors of success for antegrade wiring in CTO interventions.
Main Methods:
- Analysis of data from the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS CTO).
- Examination of 13,563 CTO PCIs performed between 2012 and 2023 across 46 centers.
- Multivariable logistic regression to identify independent predictors of antegrade wiring crossing success.
Main Results:
- A primary antegrade wiring strategy was employed in 83.6% of CTO PCIs.
- Factors associated with successful antegrade wiring included proximal cap ambiguity, side branch at proximal cap, blunt/no stump, lesion length, calcification, proximal tortuosity, distal cap bifurcation, LAD/LCX CTO location, non-in-stent restenosis, and good distal landing zone.
- Proximal cap ambiguity, blunt/no stump, lesion length, calcification, proximal tortuosity, and distal cap bifurcation were negatively associated with success, while LAD/LCX CTO location and good distal landing zone were positively associated.
Conclusions:
- Antegrade wiring is a highly utilized initial strategy for CTO PCI.
- Key clinical and angiographic parameters significantly influence the success rates of primary antegrade wiring in CTO interventions.
Background:
Antegrade wiring is the most commonly used chronic total occlusion (CTO) crossing technique.
Methods:
Using data from the PROGRESS CTO registry (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; Clinicaltrials.gov identifier: NCT02061436), we examined the clinical and angiographic characteristics and procedural outcomes of CTO percutaneous coronary interventions (PCIs) performed using a primary antegrade wiring strategy.
Results:
Of the 13 563 CTO PCIs performed at 46 centers between 2012 and 2023, a primary antegrade wiring strategy was used in 11 332 (83.6%). Upon multivariable logistic regression analysis, proximal cap ambiguity (odds ratio [OR]: 0.52; 95% CI, 0.46-0.59), side branch at the proximal cap (OR: 0.85; 95% CI, 0.77-0.95), blunt/no stump (OR: 0.52; 95% CI: 0.47-0.59), increasing lesion length (OR [per 10 mm increase]: 0.79; 95% CI, 0.76-0.81), moderate to severe calcification (OR: 0.73; 95% CI, 0.66-0.81), moderate to severe proximal tortuosity (OR: 0.67; 95% CI, 0.59-0.75), bifurcation at the distal cap (OR: 0.66; 95% CI, 0.59-0.73), left anterior descending artery CTO (OR [vs right coronary artery]: 1.44; 95% CI, 1.28-1.62) and left circumflex CTO (OR [vs right coronary artery]: 1.22; 95% CI, 1.07-1.40), non-in-stent restenosis lesion (OR: 0.56; 95% CI, 0.49-0.65), and good distal landing zone (OR: 1.18; 95% CI, 1.06-1.32) were independently associated with primary antegrade wiring crossing success.
Conclusions:
The use of antegrade wiring as the initial strategy was high (83.6%) in our registry. We identified several parameters associated with primary antegrade wiring success.
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