Document Type

Conference Proceeding

Publication Date

9-1-2022

Publication Title

J Am Coll Cardiol

Abstract

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)

Volume

80

Issue

12

First Page

B51

Last Page

B52

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