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Impact of Postprocedural Graft Flow on Outcomes Following Chronic Total Occlusion Intervention in Postcoronary Artery
Enrico Poletti1, Jo Dens2, Mohaned Egred3
1HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.
Insights
Maintaining graft patency after percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) in patients with prior coronary artery bypass graft (CABG) surgery is crucial for long-term success. Successful PCI depends on graft status, impacting CTO failure rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Chronic total occlusions (CTOs) are common in patients with prior coronary artery bypass graft (CABG) surgery.
- Percutaneous coronary intervention (PCI) is a standard treatment for CTOs, but outcomes in grafted vessels are not well understood.
- The impact of graft status and patency on CTO-PCI durability requires investigation.
Purpose of the Study:
- To assess the influence of post-PCI graft patency on the long-term durability of CTO-PCI in patients with previous CABG.
- To compare outcomes between grafted and non-grafted CTOs, and between occluded and patent grafts post-PCI.
Main Methods:
- A multicenter study involving 259 patients with previous CABG undergoing CTO-PCI between 2019 and 2023.
- Patients were categorized into grafted and non-grafted groups; grafted patients were further classified by graft patency (occluded vs. patent).
- Primary endpoints included technical success, target vessel failure, and CTO failure at 1 year.
Main Results:
- Grafted CTOs were more complex, with lower technical success rates (70%) compared to non-grafted CTOs (80%).
- Among grafted CTOs, those with occluded grafts had lower technical success (65%) than those with patent grafts (81%).
- An occluded graft predicted technical failure, while persistent graft patency predicted CTO failure at 1 year.
Conclusions:
- Post-PCI graft patency is a significant factor influencing CTO failure in patients with prior CABG.
- Maintaining graft patency post-CTO-PCI is critical for achieving durable revascularization outcomes.
- Grafted CTOs present higher complexity and poorer procedural success, emphasizing the importance of graft status assessment.
Abstract:
Chronic total occlusions (CTOs) are frequent in patients with previous coronary artery bypass graft (CABG) surgery. Percutaneous coronary intervention (PCI) is the usual revascularization strategy. Whether or not the presence of a graft on a CTO vessel and post-PCI graft patency impacts outcomes after CTO-PCI is unknown. We sought to evaluate the impact of post-PCI graft patency on the durability of CTO-PCI. In total, 259 patients with previous CABG who underwent CTO-PCI in 12 international centers in 2019 to 2023 were categorized into "grafted" and "ungrafted" groups based on the presence of graft on a CTO vessel. The grafted group was subdivided into "graft-occluded" and "graft-patent" groups, depending on graft patency. The primary end points were (1) technical success rate, (2) target vessel failure, and (3) CTO failure rates at 1 year. CTO failure was defined as target vessel revascularization and/or significant in-stent restenosis. A total of 199 patients (77%) were in the grafted group. Grafted CTOs showed higher complexity and lower technical success rates (70% vs 80%, p = 0.004) than nongrafted CTOs. Of the grafted CTOs, 140 (70%) were in the grafted-occluded group and 59 (30%) were in the grafted-patent group. The technical success was lower in the former group (65% vs 81%, p = 0.022). An occluded graft was an independent predictor of technical failure (odds ratio 2.04, 95% confidence interval 1.03 to 4.76, p = 0.049) and persistent post-PCI graft patency was a strong independent predictor of CTO failure at 1 year (hazard ratio 5.6, 95% confidence interval 1.2 to 27.5, log-rank p = 0.033). In conclusion, in patients with previous CABG who underwent CTO-PCI, post-PCI graft patency was a significant predictor of CTO failure.
