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Circ Cardiovasc Interv. 2019 Mar;12(3):e007338. doi: 10.1161/CIRCINTERVENTIONS.118.007338.

In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery.

Author information

1
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (P.T., M.N.B., I.X., L.I.S., B.V.R., E.S.B.).
2
Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Hungary (P.T., I.U.).
3
Columbia University, New York, NY (D.K., J.W.M., N.J.L., M.P., A.J.K., Z.A.A., D.D.).
4
Henry Ford Hospital, Detroit, MI (K.A.).
5
Massachusetts General Hospital, Boston (F.A.J.).
6
Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.).
7
VA San Diego Healthcare System and University of California San Diego, La Jolla (M.P., E.M.).
8
Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.).
9
Medical Center of the Rockies, Loveland, CO (A.H.D., P.D.).
10
University of Pittsburgh Medical Center, PA (C.T., A.J.C.S.).
11
VA Central Arkansas Healthcare System, Little Rock (B.U.).
12
The Heart Hospital Baylor Plano, TX (E.H., S.P.).
13
Torrance Memorial Medical Center, CA (R.M.W.).
14
Piedmont Heart Institute, Atlanta, GA (D.E.K.).
15
VA Minneapolis Healthcare System and University of Minnesota (S.G.).
16
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk (O.K., D.K.).
17
Korgialeneio-Benakeio Hellenic Red Cross General Hospital of Athens, Greece (M.K., I.T.).
18
Emory University, Atlanta, GA (W.J., H.S.).
19
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas (S.B., E.S.B.).

Abstract

BACKGROUND:

We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG).

METHODS AND RESULTS:

We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32% of total cohort) were older (67±9 versus 63±10 years; P<0.001) and had more comorbidities and lower left ventricular ejection fraction (50% [40-58] versus 55% [45-60]; P<0.001). The CTO target vessel in prior CABG patients was the right coronary artery (56%), circumflex (26%), and left anterior descending artery (17%). The mean J-CTO (2.9±1.2 versus 2.2±1.3; P<0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; 1.5±1.1 versus 1.2±1.0; P<0.001) score was higher in prior CABG patients. Retrograde (53% versus 30%, P<0.001) and antegrade dissection reentry (35% versus 28%; P<0.001) techniques were used more frequently in prior CABG patients. Prior CABG patients had lower technical (84% versus 89%; P<0.001) and procedural (82% versus 87%, P<0.001) success, but similar incidence of in-hospital major complications (3.1% versus 2.5%; P=0.287). In-hospital mortality (1% versus 0.4%; P=0.016) and coronary perforation (7.1% versus 3.1%; P<0.001) occurred more frequently in prior CABG patients, however, CABG patients had a lower incidence of pericardial tamponade (0.1% versus 1.0%; P=0.002) and pericardiocentesis (0% versus 1.3%; P<0.001).

CONCLUSIONS:

In a large multicenter CTO percutaneous coronary interventions registry, prior CABG patients had lower success rate but similar overall risk for complications, although mortality was higher and the incidence of tamponade was lower.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov . Unique identifier: NCT02061436.

KEYWORDS:

chronic total occlusion; coronary bypass graft surgery; outcomes; percutaneous coronary intervention; perforation

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