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Int J Cardiol. 2019 Jul 3. pii: S0167-5273(18)37361-3. doi: 10.1016/j.ijcard.2019.06.077. [Epub ahead of print]

Impact of concomitant treatment of non-chronic total occlusion lesions at the time of chronic total occlusion intervention.

Author information

1
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
2
Columbia University, New York, NY, USA.
3
Henry Ford Hospital, Detroit, MI, USA.
4
Massachusetts General Hospital, Boston, MA, USA.
5
Beth Israel Deaconess Medical Center, Boston, MA, USA.
6
VA San Diego Healthcare System and University of California San Diego, La Jolla, CA, USA.
7
Baylor Heart and Vascular Hospital, Dallas, TX, USA.
8
Medical Center of the Rockies, Loveland, CO, USA.
9
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
10
VA Central Arkansas Healthcare System, Little Rock, AR, USA.
11
Meshalkin Novosibirsk Research Institute, Novosibirsk, Russia.
12
The Heart Hospital Baylor Plano, Plano, TX, USA.
13
Torrance Memorial Medical Center, Torrance, CA, USA.
14
Piedmont Heart Institute, Atlanta, GA, USA.
15
Red Cross Hospital of Athens, Athens, Greece.
16
Cleveland Clinic, Cleveland, OH, USA.
17
Emory University Hospital Midtown, Atlanta, GA, USA.
18
Tristar Centennial Medical Center, Nashville, TN, USA.
19
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; University of Szeged, Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, Szeged, Hungary.
20
VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
21
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA. Electronic address: esbrilakis@gmail.com.

Abstract

BACKGROUND:

During chronic total occlusion (CTO) percutaneous coronary intervention (PCI), sometimes non-CTO lesions are also treated.

METHODS:

We compared the clinical and procedural characteristics and outcomes of CTO PCIs with and without concomitant treatment of a non-CTO lesion in a contemporary multicenter CTO registry.

RESULTS:

Of the 3598 CTO PCIs performed at 21 centers between 2012 and 2018, 814 (23%) also included PCI of at least one non-CTO lesion. Patients in whom non-CTO lesions were treated were older (65 ± 10 vs. 64 ± 10 years, p = 0.03), more likely to present with an acute coronary syndrome (32% vs. 23%, p < 0.01), and less likely to undergo PCI of a right coronary artery (RCA) CTO (46% vs. 58%, p < 0.01). The most common non-CTO lesion location was the left anterior descending artery (31%), followed by the circumflex (29%) and the RCA (25%).Combined non-CTO and CTO-PCI procedures had similar technical (88% vs. 87%, p = 0.33) and procedural (85% vs. 85%, p = 0.74) success and major in-hospital complication rates (3.4% vs. 2.7%, p = 0.23), but had longer procedure duration (131 [88, 201] vs. 117 [75, 179] minutes, p < 0.01), higher patient air kerma radiation dose (3.0 [1.9, 4.8] vs. 2.8 [1.5, 4.6] Gray, p < 0.01) and larger contrast volume (300 [220, 380] vs. 250 [180, 350] ml, p < 0.01).

CONCLUSIONS:

Combined CTO PCI with PCI of non-CTO lesions is associated with similar success and major in-hospital complication rates compared with cases in which only CTOs were treated, but requires longer procedure duration and higher radiation dose and contrast volume.

KEYWORDS:

Chronic total occlusions; Percutaneous coronary interventions

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