Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Karmpaliotis D, Jaffer F, Khatri J, Poommipanit P, Gorgulu S, Goktekin O, Krestyaninov O, Davies R, ElGuindy A, Haddad E, Kerrigan J, Patel M, Chandwaney R, Mastrodemos O, Allana S, Rangan B, and Brilakis E. TCT-123 Predictors of Success in Primary Retrograde Strategy in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry. J Am Coll Cardiol 2022; 80(12):B51-B52.
J Am Coll Cardiol
Background: An upfront (primary) retrograde strategy is often used in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: We examined the clinical, angiographic characteristics, and procedural outcomes of CTO PCIs that were approached with a primary retrograde strategy in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO; NCT02061436). Interventional collaterals were defined as collaterals that appeared suitable for retrograde CTO PCI.
Results: Of 10,286 CTO PCIs, a primary retrograde strategy was used in 1,329 (13%) with an initial technical success of 66% and a final success of 83% with subsequent strategies. Successful vs unsuccessful primary retrograde cases had similar baseline characteristics with high prior coronary artery bypass graft surgery (52% vs 53%, P = 0.682), respectively. The PROGRESS-CTO score (1.3 ± 0.9 vs 1.6 ± 0.9, P < 0.001), air kerma radiation (3.9 ± 2.8 vs 3.4 ± 2.6 Gray, P = 0.013), and contrast (294 ± 148 mL vs 248 ± 128 mL, P < 0.001) were higher in the unsuccessful group, whereas the presence of interventional collaterals (95% vs 72%, P < 0.001) and Werner collateral connection grade 2 (43% vs 31%, P < 0.001) were higher in the successful group. On multivariable logistic regression analysis, the only variable associated with a successful primary retrograde strategy was the presence of interventional collaterals: odds ratio 6.52, 95% confidence interval 3.5-12.1, P < 0.001.
Conclusion: Presence of interventional collaterals is independently associated with higher success rates with a primary retrograde strategy in CTO PCI.
Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)