TCT CONNECT-236 Percutaneous Coronary Intervention of Chronic Total Occlusions Involving a Bifurcation: Insights From the PROGRESS-CTO Registry
Nikolakopoulos I, Alaswad K, Choi J, Khatri J, Yeh R, Krestyaninov O, Khelimskii D, Jaffer FA, Rafeh NA, ElGuindy A, Goktekin O, Karmpaliotis D, Poomipanit P, Vemmou E, Karacsonyi J, Rangan B, Garcia S, Banerjee S, Burke MN, and Brilakis E. TCT CONNECT-236 Percutaneous Coronary Intervention of Chronic Total Occlusions Involving a Bifurcation: Insights From the PROGRESS-CTO Registry. Journal of the American College of Cardiology 2020; 76(17):B104.
Journal of the American College of Cardiology
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.