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Am J Cardiol. 2016 Apr 15;117(8):1267-71. doi: 10.1016/j.amjcard.2016.01.021. Epub 2016 Jan 28.

Effect of Previous Failure on Subsequent Procedural Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention (from a Contemporary Multicenter Registry).

Author information

1
Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
2
Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas.
3
Division of Cardiology, Department of Medicine, Columbia University, New York, New York.
4
Department of Cardiology, Henry Ford Hospital, Detroit, Michigan.
5
Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
6
Department of Cardiology, Torrance Memorial Medical Center, Torrance, California.
7
Division of Cardiology, University of Washington, Seattle, Washington.
8
Department of Cardiology, Mid America Heart Institute, Kansas City, Missouri.
9
Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia.
10
Department of Medicine, Minneapolis Veterans Affairs Health Care System, University of Minnesota, Minneapolis, Minnesota.
11
Department of Cardiology, Medical Center of the Rockies, Loveland, Colorado.
12
Department of Cardiology, Veterans Affairs San Diego Health Care System, University of California San Diego, San Diego, California.
13
Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
14
Boston Scientific, Natick, Massachusetts.
15
Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: esbrilakis@gmail.com.

Abstract

We sought to examine the impact of previous failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic characteristics and procedural outcomes of 1,213 consecutive patients who underwent 1,232 CTO PCIs from 2012 to 2015 at 12 US centers. Mean age was 65 ± 10 years, and 84.8% of patients were men. A previously failed attempt had been performed in 215 patients (17.5%). As compared with patients without previous CTO PCI failure, patients with previous failure had higher Multicenter CTO Registry in Japan CTO score (2.40 ± 1.13 vs 3.28 ± 1.29, p <0.0001) and were more likely to have in-stent restenosis (10.5% vs 28.4%, p <0.0001) and to undergo recanalization attempts using the retrograde approach (41% vs 50%, p = 0.011). Technical (90% vs 88%, p = 0.390) and procedural (89% vs 86%, p = 0.184) success were similar in the 2 study groups; however, median procedure time (125 vs 142 minutes, p = 0.026) and fluoroscopy time (45 vs 55 minutes, p = 0.015) were longer in the previous failure group. In conclusion, a previously failed CTO PCI attempt is associated with higher angiographic complexity, longer procedural duration, and fluoroscopy time, but not with the success and complication rates of subsequent CTO PCI attempts.

PMID:
26899493
PMCID:
PMC4811706
DOI:
10.1016/j.amjcard.2016.01.021
[Indexed for MEDLINE]
Free PMC Article

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