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Am J Cardiol. 2018 Aug 1;122(3):381-387. doi: 10.1016/j.amjcard.2018.04.021. Epub 2018 May 1.

In-hospital Outcomes of Attempting More Than One Chronic Total Coronary Occlusion Through Percutaneous Intervention During the Same Procedure.

Author information

1
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
2
Henry Ford Hospital, Detroit, Michigan.
3
Columbia University, New York, New York.
4
Massachusetts General Hospital, Boston, Massachusetts.
5
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
6
VA San Diego Healthcare System and University of California San Diego, La Jolla, California.
7
Baylor Heart and Vascular Hospital, Dallas, Texas.
8
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
9
Medical Center of the Rockies, Loveland, Colorado.
10
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
11
VA Central Arkansas Healthcare System, Little Rock, Arkansas.
12
The Heart Hospital Baylor Plano, Plano, Texas.
13
Torrance Memorial Medical Center, Torrance, California.
14
Piedmont Heart Institute, Atlanta, Georgia.
15
VA Minneapolis Healthcare System and University of Minnesota, Minneapolis, Minnesota.
16
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation.
17
Korgialeneio-Benakeio Hellenic Red Cross General Hospital of Athens, Athens, Greece.
18
Emory University Hospital, Atlanta, Georgia.
19
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
20
University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
21
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota. Electronic address: esbrilakis@gmail.com.

Abstract

The frequency and outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of more than one CTO during the same procedure have received limited study. We compared the clinical and angiographic characteristics and procedural outcomes of patients who underwent treatment of single versus >1 CTOs during the same procedure in 20 centers from the United States, Europe, and Russia. A total of 2,955 patients were included: mean age was 65 ± 10 years and 85% were men with high prevalence of previous myocardial infarction (46%), and previous coronary artery bypass graft surgery (33%). More than one CTO lesions were attempted during the same procedure in 58 patients (2.0%) and 70% of them were located in different major epicardial arteries. Compared with patients who underwent PCI of a single CTO, those who underwent PCI of >1 CTOs during the same procedure had similar J-CTO (2.4 ± 1.3 vs 2.5 ± 1.3, p = 0.579) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (1.5 ± 1.2 vs 1.3 ± 1.0 p = 0.147) scores. The multi-CTO PCI group had similar technical success (86% vs 87%, p = 0.633), but higher risk of in-hospital major complications (10.3% vs 2.7%, p = 0.005), and consequently numerically lower procedural success (79% vs 85%, p = 0.197). The multi-CTO PCI group had higher in-hospital mortality (5.2% vs 0.5%, p = 0.005) and stroke (5.2%vs 0.2%, p <0.001), longer procedure duration (162 [117 to 242] vs 122 [80 to 186] minutes, p <0.001) and higher radiation dose (3.6 [2.1 to 6.4] vs 2.9 [1.7 to 4.7] Gray, p = 0.033). In conclusion, staged revascularization may be the preferred approach in patients with >1 CTO lesions requiring revascularization, as treatment during a single procedure was associated with higher risk for periprocedural complications.

PMID:
30201106
DOI:
10.1016/j.amjcard.2018.04.021
[Indexed for MEDLINE]

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