Outcomes of Left Main Chronic Total Occlusion Percutaneous Coronary Interventions
Recommended Citation
Strepkos D, Alexandrou M, Mutlu D, Carvalho PEP, Choi JW, Gorgulu S, Jaffer FA, Chandwaney R, Alaswad K, Basir MB, Azzalini L, Mastrodemos OC, Rangan BV, Voudris K, Jalli S, Burke MN, Sandoval Y, and Brilakis ES. Outcomes of Left Main Chronic Total Occlusion Percutaneous Coronary Interventions. Catheter Cardiovasc Interv 2024.
Document Type
Article
Publication Date
1-1-2025
Publication Title
Catheterization and cardiovascular interventions
Abstract
BACKGROUND: Percutaneous coronary intervention (PCI) of left main (LM) chronic total occlusions (CTO) has received limited study.
METHODS: We compared the clinical and procedural characteristics and outcomes of patients who underwent LM versus non-LM CTO PCI at 41 US and non-US centers between 2012 and 2024.
RESULTS: During the study period 85 of 15,254 CTO PCIs (0.6%) performed in 14,969 patients were LM CTO PCIs. LM CTO PCI patients were older, had higher rates of dyslipidemia and heart failure and most (88.8%) had prior coronary artery bypass graft surgery (CABG). They were more likely to have moderately or severely calcified lesions (80.7% vs. 45.7%, p < 0.001) and had higher J-CTO (2.76 ± 1.17 vs. 2.37 ± 1.26, p = 0.008), PROGRESS-CTO MACE (3.56 vs. 2.57, p < 0.001), Mortality (2.45 vs. 1.68, p < 0.001), Pericardiocentesis (2.74 vs. 1.87, p < 0.001), Acute MI (1.72 vs. 0.89, p < 0.001) and Perforation (3.21 vs. 2.19, p < 0.001) scores. There was no difference in technical success (80.5% vs. 87.2%, p = 0.086) or major cardiovascular adverse events (MACE) (2.4% vs. 2.0%, p = 0.700). LM CTO PCI patients with and without prior CABG surgery had similar technical success and MACE. The retrograde approach in prior CABG patients was more likely to be performed through saphenous vein grafts.
CONCLUSIONS: LM CTO PCI is infrequently performed, is associated with high comorbidity burden and angiographic complexity but can be performed with high success and acceptable complication rates.
Medical Subject Headings
Humans; Coronary Occlusion; Male; Percutaneous Coronary Intervention; Female; Treatment Outcome; Aged; Chronic Disease; Risk Factors; Middle Aged; Time Factors; United States; Risk Assessment; Retrospective Studies; Registries
PubMed ID
39543076
ePublication
ePub ahead of print
Volume
105
Issue
1
First Page
23
Last Page
31
