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Am J Cardiol. 2017 Jul 1;120(1):40-46. doi: 10.1016/j.amjcard.2017.03.263. Epub 2017 Apr 13.

Impact of Calcium on Chronic Total Occlusion Percutaneous Coronary Interventions.

Author information

1
Department of Cardiology, Veterans Affairs North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
2
Interventional Cardiology, Columbia University, New York, New York.
3
Cardiac Catheterization Laboratory, Henry Ford Hospital, Detroit, Michigan.
4
Coronary Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
5
Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
6
Division of Cardiovascular Medicine, Veterans Affairs San Diego Healthcare System and University of California San Diego, San Diego, California.
7
Division of Cardiology, University of Washington, Seattle, Washington.
8
Cardiac Catheterization Laboratory, Torrance Memorial Medical Center, Torrance, California.
9
Department of Cardiology, Medical Center of the Rockies, Loveland, Colorado.
10
Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia.
11
Department of Medicine, Minneapolis Veterans Affairs Healthcare System and University of Minnesota, Minneapolis, Minnesota.
12
Department of Cardiology, Veterans Affairs North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
13
Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary.
14
Interventional Cardiology, Boston Scientific, Natick, Massachusetts.
15
Department of Cardiology, Veterans Affairs North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas; Center for Advanced Coronary Interventions, Minneapolis Heart Institute, Minneapolis, Minnesota. Electronic address: esbrilakis@gmail.com.

Abstract

We sought to examine the impact of calcific deposits on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The outcomes of 1,476 consecutive CTO PCIs performed in 1,453 patients (65.5 ± 10 years, 85% male) between 2012 and 2016 at 11 US centers were evaluated. Moderate or severe quantity of calcium was present in 58% of target lesions. Calcified lesions were more tortuous and more likely to have proximal cap ambiguity and interventional collaterals. PCI of moderately/severely calcified CTOs more often required use of the retrograde approach (54% vs 30%, p <0.001) and was associated with longer procedure and fluoroscopy time and higher air kerma radiation dose and contrast volume. Moderate/severe quantity of calcium was associated with lower technical (86.6% vs 93.8%, p <0.001) and procedural (84.4% vs 92.7%, p <0.001) success rates and higher incidence of major adverse cardiac events (3.7% vs 1.8%, p = 0.033). On multivariate analysis, the presence of moderate/severe quantity of calcium was not independently associated with technical success. Balloon angioplasty was the most common lesion preparation technique for calcified lesions, followed by rotational atherectomy and laser. To conclude, in a contemporary, multicenter registry, moderate/severe calcific deposits were present in 58% of attempted CTO lesions and were associated with higher use of the retrograde approach, lower success, and higher complication rates. However, on multivariable analysis, the amount of calcium was not independently associated with technical success.

PMID:
28499595
DOI:
10.1016/j.amjcard.2017.03.263
[Indexed for MEDLINE]

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