TCT-68 Chronic Total Occlusion Percutaneous Coronary Intervention for Patients With Previous CABG: Insights From a Pooled Analysis of 4 Multicenter Registries

Document Type

Conference Proceeding

Publication Date


Publication Title

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.





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