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Rev Esp Cardiol (Engl Ed). 2019 May;72(5):373-382. doi: 10.1016/j.rec.2018.05.020. Epub 2018 Jun 25.

Procedural, Functional and Prognostic Outcomes Following Recanalization of Coronary Chronic Total Occlusions. Results of the Iberian Registry.

[Article in English, Spanish]

Author information

1
Servicio de Cardiología, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain. Electronic address: ijamat@gmail.com.
2
Servicio de Cardiología, Hospital Clínic de Barcelona, Barcelona, Spain.
3
Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
4
Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain.
5
Servicio de Cardiología, Hospital Campus de la Salud y Virgen de las Nieves, Granada, Spain.
6
Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
7
Servicio de Cardiología, Hospital Reina Sofía de Córdoba, Córdoba, Spain.
8
Servicio de Cardiología, Hospital La Princesa, Madrid, Spain.
9
Servicio de Cardiología, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain.
10
Servicio de Cardiología, Hospital de Tarragona, Tarragona, Spain.
11
Servicio de Cardiología, Hospital del Mar, Barcelona, Spain.
12
Servicio de Cardiología, Hospital de Tenerife, Santa Cruz de Tenerife, Spain.
13
Servicio de Cardiología, Hospital General de Valencia, Valencia, Spain.
14
Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain.
15
Servicio de Cardiología, Hospital Clínico Universitario de Albacete, Albacete, Spain.
16
Servicio de Cardiología, Hospital de Murcia, Murcia, Spain.
17
Servicio de Cardiología, Complejo Hospitalario de Burgos, Burgos, Spain.
18
Servicio de Cardiología, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain.
19
Servicio de Cardiología, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain.
20
Servicio de Cardiología, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain.
21
Servicio de Cardiología, Hospital de León, León, Spain.
22
Servicio de Cardiología, Hospital Son Espases, Palma de Mallorca, Balearic Islands, Spain.
23
Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain.
24
Servicio de Cardiología, Hospital de La Paz, Madrid, Spain.
25
Servicio de Cardiología, Hospital Hospiten, Santa Cruz de Tenerife, Spain.
26
Servicio de Cardiología, Hospital Virgen Macarena, Sevilla, Spain.
27
Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
28
Servicio de Cardiología, Hospital Galdakao, Galdakao, Vizcaya, Spain.
29
Servicio de Cardiología, Hospital de Ciudad Real, Ciudad Real, Spain.
30
Servicio de Cardiología, Hospital de Alicante, Alicante, Spain.
31
Servicio de Cardiología, Hospital Clínico de Zaragoza, Zaragoza, Spain.
32
Servicio de Cardiología, Hospital García de Orta, Almada, Portugal.
33
Servicio de Cardiología, Hospital Espírito Santo, Evora, Portugal.

Abstract

INTRODUCTION AND OBJECTIVES:

There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting.

METHODS:

Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers.

RESULTS:

A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59.2%). Previous recanalization attempts had been made in 15%. The mean SYNTAX score was 19.5 ± 10.6 and J-score was > 2 in 17.3%. A retrograde procedure was performed in 92 patients (9.2%). The success rate was 74.9% and was higher in patients without previous attempts (82.2% vs 75.2%; P = .001), those with a J-score ≤ 2 (80.5% vs 69.5%; P = .002), and in intravascular ultrasound-guided PCI (89.9% vs 76.2%, P = .001), which was an independent predictor of success. In contrast, severe calcification, length > 20mm, and blunt proximal cap were independent predictors of failed recanalization. The rate of procedural complications was 7.1%, including perforation (3%), myocardial infarction (1.3%), and death (0.5%). At 1-year of follow-up, 88.2% of successfully revascularized patients showed clinical improvement (vs 34.8%, P < .001), which was associated with lower mortality. At 1-year of follow-up, the mortality rate was 1.5%.

CONCLUSIONS:

Compared with other national registries, patients in the Iberian registry undergoing PCI of a CTO showed similar complexity, success rate, and complications. Successful recanalization was strongly associated with functional improvement, which was related to lower mortality.

KEYWORDS:

CTO; Cardiopatía isquémica crónica; Chronic ischemic cardiomyopathy; Chronic total occlusions; IVUS; OCT; Oclusiones crónicas

PMID:
29954721
DOI:
10.1016/j.rec.2018.05.020

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