Original title: Procedural Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention. A Report From the NCDR (National Cardiovascular Data Registry). Reference: Emanuel S. Brilakis, et al. JACC Cardiovascular Intervention 2015;8:245-53
Chronic total occlusions (CTO) are present in 20% to 50% of pathological coronary angiograms but, even though this percentage has increased in the past years, PCI is performed in around 4% of this kind of lesions.
This study included 594,510 stable patients; 22,365 of them (3.8%) received CTO PCI. Patients presenting CTO were younger, more frequently men, often with prior infarction, prior PCI and ventricular failure.
Procedural success was lower for CTO (59% vs. 96%; p<0.001), with marked variability in centers and operators. Procedural success was associated to the annual volume of CTO PCIs of operators, 10 being 53%, 62% and 75% (p<0.001). The group requiring vessel revascularization required greater contrast volume and longer fluoroscopy time.
Procedural success also increased with operator experience, 55.5% in 2009 to 61.9% in 2013 (p<0.01). Multivariable analysis associated lower procedural success to age, smoking, previous myocardial infarction, previous CABG, previous peripheral heart disease, right coronary artery CTO target vessel and less operator experience.
Combined events resulted higher in CTO PCIs than in conventional PCIs (1.6% vs. 0.8% p<0.001). More operator experience was associated to a lower events risk.
Conclusion
CTO PCI is not frequent in USA in stable patients and is associated to a lower procedural success and a higher complications rate, compared to outcomes in patients that do not present CTO. Success is associated with patient characteristics and operator experience.
Editorial Comment
When performing CTI success will depend on operator and center. Different studies have shown the benefits of revascularization, especially when it comes to the anterior descending artery.
Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation– Argentina
Carlos Fava