Distal Target Vessel Quality and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention.
Recommended Citation
Allana SS, Kostantinis S, Simsek B, Karacsonyi J, Rempakos A, Alaswad K, Krestyaninov O, Khelimskiid D, Karmpaliotis D, Jaffer FA, Khatri JJ, Poommipanit P, Patel MP, Mahmud E, Koutouzis M, Tsiafoutis I, Gorgulu S, Elbarouni B, Nicholson W, Jaber W, Rinfret S, Rafeh NA, Goktekin O, ElGuindy AM, Sandoval Y, Burke MN, Rangan BV, and Brilakis ES. Distal Target Vessel Quality and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16(12):1490-1500.
Document Type
Article
Publication Date
6-26-2023
Publication Title
JACC Cardiovasc Interv
Abstract
BACKGROUND: Distal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm.
OBJECTIVES: The study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention.
METHODS: We examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as(MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke.
RESULTS: A total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01).
CONCLUSIONS: A poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose.
Medical Subject Headings
Humans; Treatment Outcome; Stroke; Myocardial Infarction; Algorithms; Percutaneous Coronary Intervention
PubMed ID
37380231
Volume
16
Issue
12
First Page
1490
Last Page
1500
