The impact of peripheral artery disease in chronic total occlusion percutaneous coronary intervention

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Conference Proceeding

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Catheter Cardiovasc Interv


Background: Peripheral artery disease (PAD) is a common comorbidity in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We reviewed 3,999 CTO PCIs performed in 3,914 patients between 2012 and 2018 at 25 sites in the US, Europe and Russia of whom 14% had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with prior history of PAD to those with no prior history of PAD. Results: Patients with PAD were older (67±9 vs 64±10 years, p < 0.001) and had higher incidence of cardiovascular risk factors, such as diabetes (50% vs 41%, p < 0.001), hypertension (95% vs 90%, p < 0.001) and dyslipidemia (94% vs 88%, p < 0.001). PAD patients had more complex lesions as illustrated by higher J-CTO score (2.7±1.2 vs 2.4±1.3, p < 0.001). Antegrade wire escalation was a less successful crossing strategy for PAD patients compared to those without PAD (Figure 1). Technical success was similar between the two groups (84% vs 87%, p = 0.127) while procedural success was higher for patients without PAD (81% vs 85%, p = 0.015). In-hospital major cardiac event rates were higher for patients with PAD (3% vs 2%, p = 0.046) driven by the higher percentage of tamponade needing pericardiocentesis (1.8% vs 0.7%, p = 0.021). Median procedure time (124 [82, 200] vs 115 [73, 174] min, p = 0.003) and patient air kerma radiation dose (3.0 [1.7, 4.8] vs 2.7 [1.5, 4.5] Gray, p = 0.032) were both higher for patients diagnosed with PAD. Conclusions: Patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions and lower rates of procedural success as compared with patients without PAD. (Table Presented).




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