Frequency and Outcomes of Ad Hoc Versus Planned Chronic Total Occlusion Percutaneous Coronary Intervention: Multicenter Experience
Sandoval Y, Tajti P, Karatasakis A, Burke MN, Danek BA, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Mahmud E, Krestyaninov O, Khelimskii D, Choi JW, Doing AH, Toma C, Wyman RM, Uretsky B, Garcia S, Koutouzis M, Tsiafoutis I, Holper E, Moses JW, Lembo NJ, Parikh M, Kirtane AJ, Ali ZA, Doshi D, Kandzari DE, Karacsonyi J, Rangan BV, Thompson C, Banerjee S, and Brilakis ES. Frequency and outcomes of Ad Hoc versus planned chronic total occlusion percutaneous coronary intervention: Multicenter experience. J Invasive Cardiol 2019; 31(5):133-139.
The Journal of invasive cardiology
BACKGROUND: For patients needing coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI), a planned, staged intervention has been recommended by experts. Ad hoc CTO-PCI, however, occurs in practice.
METHODS: Observational, contemporary, multicenter, international registry. Our goals were to determine the frequency, characteristics, procedural techniques, and outcomes of patients who underwent ad hoc vs planned CTO-PCI.
RESULTS: Among 2282 patients who underwent CTO-PCI between 2012 and 2017, 318 (14%) were ad hoc. Patients undergoing ad hoc CTO-PCI had lower J-CTO, PROGRESS CTO, and PROGRESS Complications scores. Antegrade-wire escalation was used more often in ad hoc PCI (96% vs 81%; P
CONCLUSIONS: Ad hoc CTO-PCI occurs more commonly in less complex lesions and is associated with similarly high success rates as planned CTO-PCI in lower J-CTO score lesions, suggesting that ad hoc CTO-PCI may be an acceptable option for experienced hybrid operators in carefully selected cases. Complex cases, as quantified by the J-CTO score, have a higher in-hospital MACE rate and should preferably be performed following proper planning and preparation.
Medical Subject Headings
Aged; Coronary Angiography; Coronary Occlusion; Coronary Vessels; Emergency Medical Services; Female; Humans; Male; Middle Aged; Outcome and Process Assessment, Health Care; Patient Care Planning; Percutaneous Coronary Intervention; Registries; Risk Adjustment; Risk Assessment; Severity of Illness Index; Time-to-Treatment