Chronic total occlusion percutaneous coronary intervention of anomalous coronary arteries: insights from the PROGRESS CTO registry
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Published on: November 24, 2014
Gustavo M Hirata1, Athanasios Rempakos2, A Walker Boyd1
1The Christ Hospital Heart and Vascular Institute and Lindner Center for Research and Education, Cincinnati, OH, USA.
Insights
Percutaneous coronary intervention for chronic total occlusions in anomalous coronary arteries is rare but feasible. This procedure shows similar success and safety outcomes compared to non-anomalous coronary arteries despite increased complexity.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Limited data exists on the frequency and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with anomalous coronary arteries (ACA).
- Understanding these outcomes is crucial for managing complex cardiovascular cases.
Purpose of the Study:
- To investigate the clinical and angiographic characteristics of CTO PCI in ACA.
- To evaluate the procedural outcomes and safety of CTO PCI in ACA compared to non-ACA.
- To determine the frequency of CTO PCI in ACA within a large registry.
Main Methods:
- Analysis of 14,470 CTO PCIs from the PROGRESS CTO registry (2012-2023).
- Identification of 36 cases (0.24%) involving CTO PCI in ACA.
- Comparison of baseline characteristics, procedural details, success rates, and major adverse cardiac events (MACE) between ACA and non-ACA groups.
Main Results:
- ACA patients had similar baseline characteristics but their target CTO lesions were more tortuous.
- CTO PCI in ACA required longer procedure and fluoroscopy times and higher contrast volumes.
- Procedural success (91.4% vs 85.6%) and technical success (91.4% vs 87.0%) were similar between ACA and non-ACA groups.
- No major adverse cardiac events (MACE) were observed in the ACA group (0% vs 1.9% in non-ACA).
Conclusions:
- CTO PCI in ACA represents a small fraction (0.24%) of all CTO PCIs.
- While associated with increased procedural complexity, CTO PCI in ACA demonstrates comparable technical and procedural success rates to non-ACA.
- The safety profile, including MACE, is similar between CTO PCI in ACA and non-ACA patients.
Background:
There is limited information about the frequency and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in anomalous coronary arteries (ACA).
Methods:
We examined the clinical and angiographic characteristics and procedural outcomes of CTO PCI in ACA among 14,173 patients who underwent 14,470 CTO PCIs at 46 US and non-US centers between 2012 and 2023.
Results:
Of 14,470 CTO PCIs, 36 (0.24%) were CTO PCIs in an ACA. ACA patients had similar baseline characteristics as those without an ACA. The type of ACA in which the CTO lesion was found were as follows: anomalous origin of the right coronary artery (ARCA) (17, 48.5%), anomalous origin of left circumflex coronary artery (9, 25.7%), left anterior descending artery and left circumflex artery with separate origins (4, 11.4%), anomalous origin of the left anterior descending artery (2, 5.7%), dual left anterior descending artery (2, 5.7%) and woven coronary artery 1 (2.8%). The Japan CTO score was similar between both groups (2.17 ± 1.32 vs 2.38 ± 1.26, p = 0.30). The target CTO in ACA patients was more likely to have moderate/severe tortuosity (44% vs 28%, p = 0.035), required more often use of retrograde approach (27% vs 12%, p = 0.028), and was associated with longer procedure (142.5 min vs 112.00 min [74.0, 164.0], p = 0.028) and fluoroscopy (56 min [40, 79 ml] vs 42 min [25, 67], p = 0.014) time and higher contrast volume (260 ml [190, 450] vs 200 ml [150, 300], p = 0.004) but had similar procedural (91.4% vs 85.6%, p = 0.46) and technical (91.4% vs 87.0%, p = 0.59) success. No major adverse cardiac events (MACE) were seen in ACA patients (0% [0] vs 1.9% [281] in non-ACA patients, p = 1.00). Two coronary perforations were reported in ACA CTO PCI (p = 0.7 vs. non-ACA CTO PCI).
Conclusions:
CTO PCI of ACA comprise 0.24% of all CTO PCIs performed in the PROGRESS CTO registry and was associated with higher procedural complexity but similar technical and procedural success rates and similar MACE compared with non-ACA CTO PCI.
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