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Can J Cardiol. 2016 Dec;32(12):1433-1439. doi: 10.1016/j.cjca.2016.04.007. Epub 2016 Apr 22.

Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry.

Author information

1
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
2
Henry Ford Hospital, Detroit, Michigan, USA.
3
Columbia University, New York, New York, USA.
4
Massachusetts General Hospital, Boston, Massachusetts, USA.
5
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
6
VA San Diego Healthcare System and University of California San Diego, La Jolla, California, USA.
7
PeaceHealth St Joseph Medical Center, Bellingham, Washington, USA.
8
Torrance Memorial Medical Center, Torrance, California, USA.
9
Mid America Heart Institute, Kansas City, Missouri, USA.
10
Piedmont Heart Institute, Atlanta, Georgia, USA.
11
Medical Center of the Rockies, Loveland, Colorado, USA.
12
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
13
Minneapolis VA Health Care System and University of Minnesota, Minneapolis, Minnesota, USA.
14
Boston Scientific, Natick, Massachusetts, USA.
15
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address: esbrilakis@gmail.com.

Abstract

BACKGROUND:

We sought to determine the effect of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

METHODS:

We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012 and 2016 at 11 experienced US centres.

RESULTS:

Mean patient age was 66 ± 10 years and 85.6% of the patients were men. Overall technical and procedural success rates were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months (interquartile range, 3-64 months), respectively. Patients were stratified into tertiles according to lesion age (3-5, 5-36.3, and > 36.3 months). Older lesion age was associated with older patient age (68 ± 8 vs 65 ± 10 vs 64 ± 11 years; P = 0.009), previous coronary artery bypass grafting (62% vs 42% vs 30%; P < 0.001), and moderate/severe calcification (75% vs 53% vs 59%; P = 0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs 89.6% vs 93.0%; P = 0.37) or procedural (86.3% vs 87.4% vs 89.0%; P = 0.80) success, or the incidence of MACE (3.1% vs 3.0% vs 6.3%; P = 0.31) for older vs younger occlusions.

CONCLUSIONS:

Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/re-entry. Older CTOs can be recanalized with high technical and procedural success and acceptable MACE rates. Lesion age appears unlikely to be a significant determinant of CTO PCI success.

PMID:
27476986
PMCID:
PMC5075265
DOI:
10.1016/j.cjca.2016.04.007
[Indexed for MEDLINE]
Free PMC Article

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