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Can J Cardiol. 2018 Oct;34(10):1264-1274. doi: 10.1016/j.cjca.2018.07.472. Epub 2018 Jul 31.

Prevalence and Outcomes of Percutaneous Coronary Interventions for Ostial Chronic Total Occlusions: Insights From a Multicenter Chronic Total Occlusion Registry.

Author information

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

Abstract

BACKGROUND:

Ostial chronic total occlusions (CTOs) can be challenging to recanalize.

METHODS:

We sought to examine the prevalence, angiographic presentation, and procedural outcomes of ostial (side-branch ostial and aorto-ostial) CTOs among 1000 CTO percutaneous coronary interventions (PCIs) performed in 971 patients between 2015 and 2017 at 14 centres in the US, Europe, and Russia.

RESULTS:

Ostial CTOs represented 16.9% of all CTO PCIs: 9.6% were aorto-ostial, and 7.3% were side-branch ostial occlusions. Compared with nonostial CTOs, ostial CTOs were longer (44 ± 33 vs 29 ± 19 mm, P < 0.001) and more likely to have proximal-cap ambiguity (55% vs 33%, P < 0.001), moderate/severe calcification (67% vs 45%, P < 0.001), a diffusely diseased distal vessel (41% vs 26%, P < 0.001), interventional collaterals (64% vs 53%, P = 0.012), and previous coronary artery bypass graft surgery (CABG) (51% vs 27%, P < 0.001). The retrograde approach was used more often in ostial CTOs (54% vs 29%, P < 0.001) and was more often the final successful crossing strategy (30% vs 18%, P = 0.003). Technical (81% vs 84%, P = 0.280), and procedural (77% vs 83%, P = 0.112) success rates and the incidence of in-hospital major complication were similar (4.8% vs 2.2%, P = 0.108), yet in-hospital mortality (3.0% vs 0.5%, P = 0.010) and stroke (1.2% vs 0.0%, P = 0.030) were higher in the ostial CTO PCI group. In multivariable analysis, ostial CTO location was not independently associated with higher risk for in-hospital major complications (adjusted odds ratio 1.27, 95% confidence intervals 0.37 to 4.51, P = 0.694).

CONCLUSIONS:

Ostial CTOs can be recanalized with similar rates of success as nonostial CTOs but are more complex, more likely to require retrograde crossing and may be associated with numerically higher risk for major in-hospital complications.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02061436.

PMID:
30269827
DOI:
10.1016/j.cjca.2018.07.472
[Indexed for MEDLINE]

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