Nikolakopoulos I, Vemmou E, Karacsonyi J, Alaswad K, Karmpaliotis D, Rafeh NA, Schimmel D, Benzuly K, Flaherty JD, Poomipanit P, ElGuindy AM, Nicholas Burke M, and Brilakis ES. Percutaneous Coronary Intervention of Chronic Total Occlusions Involving a Bifurcation: Insights from the PROGRESS-CTO Registry. Hellenic J Cardiol 2022.
Hellenic J Cardiol
BACKGROUND: The impact of bifurcations at the proximal or distal cap on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.
METHODS: We analyzed the clinical, angiographic, and procedural data of 4,584 cases performed in patients between 2012 and 2020 in a global CTO PCI registry. We compared 4 groups according to the bifurcation location: "proximal cap," "distal cap," "proximal and distal cap," and "no bifurcation."
RESULTS: The CTO involved a bifurcation in 67% cases, as follows: proximal cap (n = 1451, 33%), distal cap (n = 622, 14%), or both caps (n = 954, 21%). "Proximal and distal cap" cases had higher J-CTO compared with "proximal cap," "distal cap," and "no bifurcation" cases (2.9 ± 1.1 vs 2.5 ± 1.1 vs 2.4 ± 1.2 vs 2.0 ± 1.2, P < 0.0001), and they were also associated with a lower technical success rate (79% vs 85% vs 85% vs 90%, P < 0.0001), higher pericardiocentesis rate (1% vs 1% vs 0.2% vs 0.3%, P = 0.02), and higher emergency coronary artery bypass graft surgery rate (0.3% vs 0% vs 0% vs 0%, P = 0.01).
CONCLUSION: More than two-thirds of CTO PCIs involve a bifurcation, which is associated with lower technical success and higher risk of complications.
ePub ahead of print