TCT-68 Chronic Total Occlusion Percutaneous Coronary Intervention for Patients With Previous CABG: Insights From a Pooled Analysis of 4 Multicenter Registries
Vemmou E, Quadros A, Dens J, Rafeh NA, Agostoni P, Alaswad K, Avran A, Belli K, Campos C, Carlino M, Choi J, De Los Santos FD, ElGuindy A, Jaffer FA, Karmpaliotis D, Khatri J, Khelimskii D, Knaapen P, Krestyaninov O, La Manna A, Lamelas P, Ojeda S, Padilla L, Pan M, Piccaro de Oliveira P, Rinfret S, Santiago R, Spratt J, Walsh S, Kostantinis S, Simsek B, Karacsonyi J, Nikolakopoulos I, Rangan B, Brilakis E, and Azzalini L. TCT-68 Chronic Total Occlusion Percutaneous Coronary Intervention for Patients With Previous CABG: Insights From a Pooled Analysis of 4 Multicenter Registries. J Am Coll Cardiol 2021; 78(19):B28.
J Am Coll Cardiol
Background: The outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) in patients with previous coronary artery bypass graft surgery (CABG) have received limited study.
Methods: We examined the clinical angiographic characteristics and procedural outcomes of 11,503 CTO-PCIs performed on 11,397 patients at 108 US and international centers between 2012 and 2020, pooling patient-level data from 4 multicenter registries. In-hospital major adverse cardiovascular events included death, myocardial infarction, stroke, and tamponade.
Results: There were 2,776 patients with previous CABG (24.4% of the total cohort). Patients with previous CABG were older (68 vs 64 years old, P < 0.01) and more likely to have diabetes (48% vs 36%, P < 0.001). Patients with previous CABGs had higher J-CTO scores (2.7 ± 1.2 vs 2.1 ± 1.3, P < 0.001) and more proximal-cap ambiguity (43% vs 32%, P < 0.001) compared with patients who did not have previous CABGs. Antegrade wiring was the most used strategy in the previous CABG group (46% vs 66%), followed by retrograde crossing (35% vs 18%) and antegrade dissection and re-entry (19% vs 15%, P < 0.001). Patients with previous CABG required more contrast material (250 [175,350] vs 240 [170,331] mL, P < 0.001), and intravascular imaging was used more often (36% vs 33%, P = 0.02). Technical (80% vs 87%, P < 0.001) and procedural (79% vs 86%, P < 0.001) success rates were lower in patients who had previous CABGs but had similar incidence of in-hospital major adverse cardiovascular events (MACE) (2.5% vs 2.4%, P = 0.77).
Conclusion: CTO-PCI in patients with previous CABG is associated with lower technical and procedural success but similar in-hospital rates of major adverse cardiovascular events.