The impact of peripheral artery disease in chronic total occlusion percutaneous coronary intervention
Xenogiannis I, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel MP, Mahmud E, Choi JW, Burke MN, Doing A, Dattilo P, Toma C, Smith AJC, Uretsky BF, Krestyaninov O, Khelimskii D, Holper EM, Potluri S, Wyman RM, Kandzari DE, Garcia S, Koutouzis M, Tsiafoutis I, Khatri J, Jaber W, Samady H, Jefferson B, Patel T, Sheikh AM, Malik BA, Moses JW, Lembo NJ, Parikh MA, Kirtane AJ, Ali ZA, Gkargkoulas F, Tajti P, Hall AB, Vemmou E, Nikolakopoulos I, Rangan B, Abdullah S, Banerjee S, and Brilakis ES. The impact of peripheral artery disease in chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv 2019; 93(Suppl 2):S46-S48.
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).