Percutaneous Intervention of Circumflex Chronic Total Occlusions Is Associated With Worse Procedural Outcomes: Insights From a Multicentre US Registry

Abstract Background We sought to determine whether outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary according to CTO target vessel: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). Methods We evaluated the cl...

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Bibliographic Details
Published in:Canadian journal of cardiology 2014-12, Vol.30 (12), p.1588-1594
Main Authors: Christopoulos, Georgios, MD, Karmpaliotis, Dimitri, MD, Wyman, Michael R., MD, Alaswad, Khaldoon, MD, McCabe, James, MD, Lombardi, William L., MD, Grantham, J. Aaron, MD, Marso, Steven P., MD, Kotsia, Anna P., MD, Rangan, Bavana V., BDS, MPH, Garcia, Santiago A., MD, Lembo, Nicholas, MD, Kandzari, David, MD, Lee, James, MD, Kalynych, Anna, MD, Carlson, Harold, MD, Thompson, Craig A., MD, Banerjee, Subhash, MD, Brilakis, Emmanouil S., MD, PhD
Format: Article
Language:English
Subjects:
Aged
Cardiovascular
Chronic Disease
Coronary Angiography
Coronary Occlusion - diagnosis
Coronary Occlusion - mortality
Coronary Occlusion - surgery
Female
Follow-Up Studies
Humans
Male
Percutaneous Coronary Intervention - methods
Registries
Retrospective Studies
Survival Rate - trends
Time Factors
Treatment Outcome
United States - epidemiology
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Summary:Abstract Background We sought to determine whether outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) vary according to CTO target vessel: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). Methods We evaluated the clinical and angiographic characteristics and procedural outcomes of 636 patients who underwent CTO PCI at 6 high-volume centres in the United States between January 2012 and March 2014. Results The CTO target vessel was the RCA in 387 cases (61%), LAD in 132 (21%), and LCX in 117 (18%). LCX lesions were more tortuous and RCA lesions had greater occlusion length and Japanese Chronic Total Occlusion (J-CTO) score, but were less likely to have a side branch at the proximal cap and had more developed collateral circulation. The rate of procedural success was lower in LCX CTOs (84.6%), followed by RCA (91.7%), and LAD (94.7%) CTOs ( P  = 0.016). Major complications tended to occur more frequently in LCX PCI (4.3% vs 1.0% for RCA vs 2.3% for LAD; P  = 0.07). LCX and RCA CTO PCI required longer fluoroscopy times (45 [interquartile range (IQR), 30-74] minutes vs 45 [IQR, 21-69] minutes for RCA vs 34 [IQR, 20-60] minutes for LAD; P  = 0.018) and LCX CTOs required more contrast administration (280 [IQR, 210-370] mL vs 250 [IQR, 184-350] mL for RCA and 280 [IQR, 200-400] mL for LAD). Conclusions In a contemporary, multicentre CTO PCI registry, LCX was the least common target vessel. Compared with LAD and RCA, PCI of LCX CTOs was associated with a lower rate of procedural success, less efficiency, and a nonsignificant trend for higher rates of complications.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2014.07.007