Kostantinis S, Simsek B, Karacsonyi J, Alaswad K, Megaly M, Krestyaninov O, Khelimskii D, Jaffer F, Khatri J, Poommipanit P, Patel M, Mahmud E, Koutouzis M, Tsiafoutis I, Gorgulu S, Elbarouni B, Nicholson W, Jaber W, Rinfret S, Goktekin O, ElGuindy A, Sandoval Y, Burke MN, Allana S, Rangan B, and Brilakis E. TCT-117 Impact of Proximal Cap Ambiguity on the Outcomes of Chronic Total Occlusion Intervention: Insights From the PROGRESS-CTO Registry. J Am Coll Cardiol 2022; 80(12):B48-B49.
J Am Coll Cardiol
Background: The impact of proximal cap ambiguity on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.
Methods: We examined the clinical and angiographic characteristics and procedural outcomes of 11,169 CTO PCIs performed in 10,932 patients at 42 US and non-US centers between 2012 and 2022.
Results: Proximal cap ambiguity was present in 35% of CTO lesions. Patients whose lesions had proximal cap ambiguity were more likely to have had prior PCI (65% vs 59%; P < 0.01) and prior coronary artery bypass graft surgery (37% vs 24%; P < 0.01). Lesions with proximal cap ambiguity were more complex with higher J-CTO score (3.1 ± 1.0 vs 2.0 ± 1.2; P < 0.01) and lower technical (79% vs 90%; P < 0.01) and procedural success (77% vs 89%; P < 0.01) rates compared with non-ambiguous CTO lesions. The incidence of major adverse cardiovascular events (MACE) was higher in cases with proximal cap ambiguity (2.5% vs 1.7%; P < 0.01). The retrograde approach was more commonly used among cases with ambiguous proximal cap (51% vs 21%; P < 0.01) and was more likely to be the final successful crossing strategy (29% vs 13%; P < 0.01). PCIs of CTOs with ambiguous proximal cap required longer procedure time (140 [95-195] vs 105 [70-150] min; P < 0.01) and more contrast volume (225 [160-305] vs 200 [150-280] mL; P < 0.01).
Conclusion: Proximal cap ambiguity in CTO lesions is associated with higher utilization of the retrograde approach, lower technical and procedural success rates, and higher incidence of in-hospital MACE.
Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)