TCT-407 Clinical Characteristics and Outcomes of Impella-Supported High-Risk Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion: Insights From the cVAD PROTECT III Registry

Document Type

Conference Proceeding

Publication Date

10-29-2024

Publication Title

J Am Coll Cardiol

Keywords

all cause mortality, blood clot lysis, cerebrovascular accident, cerebrovascular disease, chronic total occlusion, complication, conference abstract, controlled study, drug therapy, female, heart infarction, human, major clinical study, male, percutaneous coronary intervention, revascularization, special situation for pharmacovigilance, SYNTAX score, therapy, transient ischemic attack, ventricular assist device

Abstract

Background: Patients (pts) with chronic coronary total occlusion (CTO) have high-risk features and greater procedural risk. Little is known about CTO pts receiving Impella-supported high-risk percutaneous coronary intervention (HRPCI). Methods: Baseline clinical and angiographic characteristics, procedural complications, and outcomes in pts with and without coronary CTOs who received Impella-supported HRPCI in the cVAD PROTECT III study (NCT04136392) were evaluated. CTO was defined as at least 1 coronary lesion with Thrombolysis In Myocardial Infarction (TIMI) grade 0 flow by independent angiographic core lab assessment. Major adverse cardiovascular and cerebrovascular events (MACCE: composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) were assessed by a clinical events committee at 30 and 90 days. Results: Of 1,237 pts enrolled in the cVAD PROTECT III study, 1,019 had angiographic core lab TIMI flow assessment; 12.6% had CTO, of which 58.5% were successfully revascularized. Patients with CTOs had longer procedures (2.4 vs 2.0 h, P = 0.0002), higher pre-PCI SYNTAX scores (31.2 vs 27.5, p = 0.004), longer lesions (18.5 vs 13.7 mm, P < 0.0001), and more lesions treated (2.7 vs 2.5, P = 0.04). There was no significant difference in PCI-related intraprocedural complications between groups. MACCE rates at 30 and 90 days were comparable between groups (P = 0.23 and P = 0.36, respectively). [Formula presented] Conclusion: Results from PROTECT III indicate that pts with a CTO undergoing Impella-supported HRPCI have higher anatomical complexity, but comparable periprocedural and acute outcomes as those without CTO. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP).

Volume

84

Issue

18

First Page

B118

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