Frequency and outcomes of ad hoc versus planned chronic total occlusion percutaneous coronary intervention: Insights from a multicenter registry
Sandoval Y, Karatasakis A, Danek B, Karacsonyi J, Karmpaliotis D, Alaswad K, Jaffer F, Yeh R, Patel M, Mahmud E, Kandzari D, Lembo N, Choi J, Lombardi W, Doing A, Wyman RM, Uretsky B, Garcia S, Toma C, Kirtane A, Moses J, Parikh M, Ali Z, Banerjee S, Brilakis E. Frequency and outcomes of ad hoc versus planned chronic total occlusion percutaneous coronary intervention: Insights from a multicenter registry. Catheter Cardiovasc Interv. 2017;89:S62-S63.
Background: Ad hoc chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is discouraged due to the perceived benefits of pre-planning, risk-benefit assessment, and understanding of the anatomic and clinical circumstances for this complex lesion/patient subset. Methods: We compared the characteristics and outcomes of patients undergoing planned vs. ad hocCTO PCI in a multicenter registry (NCT02061436). Results: Among 1,438 patients undergoing CTO PCI between 2012- 2016, 14% (n=206) were ad hoc. Patients undergoing ad hoc PCI were less likely to have prior CABG and prior PCI, but more likely to have diabetes, cerebrovascular disease, and peripheral arterial disease (all p<0.05). They also had lower rates of moderate/severe calcification, prior failed CTO PCI, proximal cap ambiguity, and a lower J-CTO score (2.2 vs. 2.7, <0.0001). Dual injection was less frequent in ad hoc vs. planned PCI (38% vs. 73%, p<0.0001). An antegrade-wire escalation strategy was used more often in ad hoc PCI (94% vs. 76%, p<0.0001), whereas antegrade-dissection reentry (22% vs. 37%) or retrograde (16% vs. 43%) approaches were more common in planned PCI (both p<0.0001). There was no difference in ad hoc vs. planned PCI in technical and procedural success rates, and in-hospital major adverse cardiac events (Figure). Conclusion: In a large, contemporary US registry with expert operators, ad hoc CTO PCI occurred in 14% ofcases. Ad hoc CTO PCI was more commonly performed in less complex lesions but was associated with similarly high success.