TCT CONNECT-236 Percutaneous Coronary Intervention of Chronic Total Occlusions Involving a Bifurcation: Insights From the PROGRESS-CTO Registry

Document Type

Conference Proceeding

Publication Date

10-22-2020

Publication Title

Journal of the American College of Cardiology

Abstract

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 6,066 cases performed for patients between 2012 and 2020 in a global CTO PCI registry. We compared 4 groups according to bifurcation location: “proximal and distal cap,” “proximal cap only,” “distal cap only,” and “no bifurcation.”

Results: The CTO involved a bifurcation in 67% cases, as follows: proximal cap (n = 2,006, 33%), distal cap (n = 815, 13%), or both caps (n = 1,268, 21%). Proximal and distal cap patients were more likely to have had prior myocardial infarction (52% vs. 45% vs. 42% vs. 44%, p < 0.001) or coronary artery bypass grafting (35% vs. 26% vs. 32% vs. 27%, p < 0.0001) when compared with proximal cap only, distal cap only, and no bifurcation groups, respectively. Proximal and distal cap cases had higher Japan-CTO (2.9 ± 1.1 vs. 2.5 ± 1.2 vs. 2.4 ± 1.3 vs. 2 ± 1.3, respectively; p < 0.0001) and greater use of the retrograde approach (47% vs. 40% vs. 30% vs. 20%, respectively; p < 0.0001). Technical success was significantly lower in the proximal and distal cap group (79% vs. 85% vs 85% vs 90%, respectively; p <0.0001), with major adverse cardiovascular event rates being similar (2.3% vs. 2.3% vs. 1.6% vs. 1.3%, respectively; p = 0.06). Compared with no bifurcation, the presence of any bifurcation was associated with higher Japan-CTO score (2.6 ± 1.2 vs. 2 ± 1.3; p < 0.0001) and lower technical success (83% vs. 90%; p < 0.0001).

Conclusion: More than two-thirds of CTO PCIs involve a bifurcation, which is associated with lower technical success but similar risk for complications.

Volume

76

Issue

17

First Page

B104

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