Impact of successful antegrade and retrograde CTO PCI on short-term prognosis
- PMID: 38816558
- PMCID: PMC11139834
- DOI: 10.1186/s43044-024-00501-6
Impact of successful antegrade and retrograde CTO PCI on short-term prognosis
Abstract
Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) carries risk of complications and should be attempted when the anticipated benefits exceed the potential risks. The primary indication for CTO-PCI is symptom improvement. However, the impact of CTO-PCI on angina and subsequent incidence of major adverse cardiovascular event (MACE) rate remains controversial. Our aim was to study the impact of technically successful elective CTO-PCI on the procedural success rate and short-term MACE. The current study was a prospective cohort study that included a total of 80 patients who were referred to our center (Ain Shams University Hospitals) for elective CTO-PCI and underwent technically successful CTO-PCI. Data were collected on patient arrival to our department, and then, the patients were observed during hospital admission to record any In-Hospital MACE. These patients were then followed up for 6 months to record improvement or worsening of their symptoms and to assess occurrence of any MACE including hospitalization and undergoing symptom-driven coronary angiography.
Results: The mean age of our patients was 56 ± 9.6 years, and 73 patients (91%) were men. Sixty-two patients (77.5%) were done via an antegrade approach, and 18 patients (22.5%) were done via a retrograde approach with an overall procedural success rate of 91.25% (antegrade 93.5%, retrograde 83.3%). The overall mean procedure time was 102 min, the mean contrast volume used was 371 ml, and the mean cumulative air kerma dose was 7.2 Gy. The retrograde group required longer procedure times, larger volumes of contrast and higher exposure to radiation. The overall in-hospital MACE was 8.75%. Sixty-five patients in our study (81.25%) showed an improvement in the grade of their exertional dyspnea or angina within the 6-month follow-up period. Thirteen patients in our study (16.25%) needed re-hospitalization within a 6-month period after PCI. The overall target lesion revascularization rate at 6 months was 8.75%.
Conclusions: Technically successful CTO PCI in a well-equipped center with highly qualified CTO operators resulted in high procedural success rates and low incidence of short-term MACE.
Keywords: Antegrade; CTO; MACE; PCI; Retrograde; TLR.
© 2024. The Author(s).
Conflict of interest statement
The authors declare that they have no competing interest.
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References
-
- Brilakis ES, Mashayekhi K, Tsuchikane E, et al. Guiding principles for chronic total occlusion percutaneous coronary intervention. Circulation. 2019;140:420–433. - PubMed
-
- Xenogiannis I, Nikolakopoulos I, Krestyaninov O, et al. Impact of successful chronic total occlusion percutaneous coronary interventions on subsequent clinical outcomes. J Invasive Cardiol. 2020;32(11):433–439. - PubMed
-
- Carline M, Magri CJ, Uretsky BF, et al. Treatment of the chronic total occlusion: a call to action for the interventional community. Catheter Cardiovasc Interv. 2015;85:771–778. - PubMed
-
- Tajti P, Karmpaliotis D, Alaswad K, et al. The hybrid approach to chronic total occlusion percutaneous coronary intervention: update from the PROGRESS CTO registry. JACC Cardiovasc Interv. 2018;11(14):1325–1335. - PubMed
-
- Fefer P, Knudtson ML, Cheema AN, et al. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry”. JACC. 2012;59(11):991–997. - PubMed
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