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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.

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Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Cardiology, Columbia University, New York, New York, USA.
Department of Cardiology, Torrance Memorial Center, Los Angeles, California, USA.
Department of Cardiology, Appleton Medical Center and Theda Clark Medical Center, Appleton, Wisconsin, USA.
Department of Cardiology, University of Washington, Seattle, Washington, USA.
Department of Cardiology, Saint Luke's Mid America Heart Institute and The University of Missouri-Kansas City, Kansas City, Missouri, USA.
Department of Cardiology, Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota, USA.
Department of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA.
Department of Cardiology, Boston Scientific, Natick, Massachusetts, USA.
Department of Cardiology, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address:



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).


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.


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).


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.

[Indexed for MEDLINE]

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