TCT CONNECT-228 In-hospital Outcomes of CTO PCI in Octogenarians and Nonagenarians: Insights From the PROGRESS-CTO Registry
Vemmou E, Alaswad K, Patel M, Mahmud E, Choi J, Jaffer FA, Doing A, Karmpaliotis D, Krestyaninov O, Khelimskii D, Nikolakopoulos I, Karacsonyi J, Xenogiannis I, Garcia S, Burke MN, Rafeh NA, ElGuindy A, Goktekin O, Abdo A, Rangan B, and Brilakis E. TCT CONNECT-228 In-hospital Outcomes of CTO PCI in Octogenarians and Nonagenarians: Insights From the PROGRESS-CTO Registry. Journal of the American College of Cardiology 2020; 76(17):B100.
Journal of the American College of Cardiology
Background: The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study.
Methods: We compared in-hospital outcomes of CTO PCI between patients ≥80 years and <80-years-old in 6,233 CTO PCIs performed in 6,050 patients between 2012 and 2020 at 33 U.S. and international centers.
Results: There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octogenarians and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.09). The most common crossing strategy used was antegrade wire escalation in both groups (84% in octogenarians/nonagenarians vs. 85% in younger patients, p = 0.64).Non-CTOs were treated at the same time in 32% of patients in the ≥80-year-old group compared with 25% in the <80-year-old group (p = 0.018). Octogenarians and nonagenarians were more likely to have balloon uncrossable (17% vs. 10%, p = 0.0006) and balloon undilatable lesions (15% vs. 9%, p = 0.006). The octogenarians/nonagenarians had lower technical and procedural success (82.2% vs. 86.3%, p = 0.02, 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (MACE) (3.4% vs. 1.8%, p = 0.02) (Figure 1). Most in-hospital MACE events were cardiac tamponade requiring pericardiocentesis (Figure 2). [Formula presented] [Formula presented]
Conclusion: CTO-PCI is feasible in octogenarians and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients.