Format

Send to

Choose Destination
Can J Cardiol. 2014 Dec;30(12):1588-94. doi: 10.1016/j.cjca.2014.07.007. Epub 2014 Jul 16.

Percutaneous intervention of circumflex chronic total occlusions is associated with worse procedural outcomes: insights from a Multicentre US Registry.

Author information

1
Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
2
Department of Cardiology, Columbia University, New York, New York, USA.
3
Department of Cardiology, Torrance Memorial Center, Los Angeles, California, USA.
4
Department of Cardiology, Appleton Medical Center and Theda Clark Medical Center, Appleton, Wisconsin, USA.
5
Department of Cardiology, University of Washington, Seattle, Washington, USA.
6
Department of Cardiology, Saint Luke's Mid America Heart Institute and The University of Missouri-Kansas City, Kansas City, Missouri, USA.
7
Department of Cardiology, Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota, USA.
8
Department of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA.
9
Department of Cardiology, Boston Scientific, Natick, Massachusetts, USA.
10
Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address: emmanouil.brilakis@utsouthwestern.edu.

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.

PMID:
25442459
DOI:
10.1016/j.cjca.2014.07.007
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center