TCT-427 Impact of Interventional Collaterals on the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention

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Background: The impact of interventional collaterals on the 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 11,205 patients who underwent 11,444 CTO PCIs at 45 U.S. and non-U.S. centers between 2012 and 2023. Results: Interventional collaterals were present in 6,553 (57%) CTO PCI cases. Compared with lesions with interventional collaterals, lesions without interventional collaterals had lower J-CTO score (2.3 ± 1.3 vs 2.4 ± 1.3; P < 0.001). In 126 (2.6%) cases, retrograde was the successful crossing strategy, despite the absence of interventional collaterals. Cases with interventional collaterals were more likely to require longer procedure (122 vs 100 min; P<0.001) and fluoroscopy (48 vs 36 min; P < 0.001) time. The presence of interventional collaterals was associated with higher technical (88.4% vs 84.1%; P < 0.001) and procedural (86.8% vs 83.2%; P < 0.001) success, but also slightly more major adverse cardiovascular events (MACE) (2.3% vs 1.5%; P = 0.004). Perforations were also more common in the presence of interventional collaterals (5.4 % vs 3.9%; P < 0.001). After adjusting for potential confounders, the presence of interventional collaterals was associated with higher technical success and no difference in MACE. [Formula presented] Conclusion: The presence of interventional collaterals is independently associated with higher rates of technical success in CTO PCI. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)

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