Determinants of success of coronary angioplasty in patients with a chronic total occlusion: a multiple logistic regression model to improve selection of patients.

Abstract

Objective-To study the determinants of success of coronary angioplasty in patients with chronic total occlusions, and to formulate a multiple logistic regression model to improve selection of patients. Design-A retrospective analysis of clinical and angiographic data on a consecutive series of patients.Patients-312 patients (mean age 55, range 31 to 79 years, 86% men) who underwent coronary angioplasty procedure for a chronic -total occlusion between 1981 and 1992. Results-Procedural success was achieved in 191 lesions (61.2%). A major complication occurred in six patients (1.90!6). Multiple stepwise logistic regression analysis identified the presence of bridging coliaterals (p < 0.001), the absence of a tapered entry configuration (p < 0.001), estimated duration of occlusion of greater than three months (p = 0.001), and a vessel diameter of less than 3 mm (p = 0.003) as independent predictors of procedural failure. The logistic regression model was used to classify patients into groups of high, intermediate, and low probability of procedural success with cut off points of 70% and 30%. The predictive value for procedural success (probability 70%/6) was 91% (95% confidence intervals (95% CI) 83% to 96%) and predictive value for procedural failure (probability <30%) was 81% (95% CI 64% to 92%). Conclusions-Percutaneous transluminal coronary angioplasty of chronic total occlusions is associated with a low risk of acute complication. Procedural success is influenced by easily identifiable clinical and angiographic features and the multiple regression model described may help to improve selection of patients. (Br Heart J 1993;70:126-13 1) Since the introduction of percutaneous transluminal coronary angioplasty by Gruentzig in 1978,1 the procedure has been applied to increasingly complex lesions including occluded vessels.2' Coronary angioplasty of chronic total occlusions is recognised to have a lower primary success rate ranging from 53% to 73%," and contributes to the failure to achieve complete revascularisation among many patients with multivessel disease.78 Despite this relatively low initial success rate, recanalisation of chronic total occlusions by coronary angioplasty has become an accepted procedure and the prevalence has increased from about 2% to 10% of the total number of coronary angioplasties performed in large centres.9 At present, the ability to predict the likelihood of procedural success for a particular lesion is poor. This study reports on the acute success and complication rates of coronary angioplasty of chronic total occlusions on 312 consecutive patients. It also describes a multiple logistic regression model incorporating clinical and angiographic data to predict probability of procedural success for a particular lesion. Patients and methods ANGIOPLASTY PROCEDURECoronary angioplasty was performed according to a previously described protocol."3 More than 60% of the procedures were performed by a single operator. Steerable guide wire systems have been in use since 1984. The techniq...

Chronic Total Occlusions

“…Traditional predictors for CTO PCI failure are increasing age of the occlusion, small vessel diameter, presence of calcium or a blunt stump, proximal cap ambiguity, excessive tortuosity, long occlusion length, bridging collaterals, and absent visibility of the distal vessel [72,89,[92][93][94][95]. Furthermore, these lesions show a higher mean Multicenter CTO Registry of Japan (J-CTO) score and have collaterals that are less likely suitable for the retrograde approach [96].…”

Chronic total occlusions

“…Traditional predictors for CTO PCI failure are increasing age of the occlusion, small vessel diameter, presence of calcium or a blunt stump, proximal cap ambiguity, excessive tortuosity, long occlusion length, bridging collaterals, and absent visibility of the distal vessel [72,89,[92][93][94][95]. Furthermore, these lesions show a higher mean Multicenter CTO Registry of Japan (J-CTO) score and have collaterals that are less likely suitable for the retrograde approach [96].…”

Magnum Meier wires with Crag Fx wire catheter for total occlusive coronary arteries

“…Although angioplasty balloon catheters and guidewires have improved, dilatation of totally occluded lesions is still not free from technical difficulties [1][2][3]. Magnum Meier recanalization guide wire (Schneider, Bulach, Switzerland) [4], which has a specially formed oliveshape tip, is one choice for crossing occlusive lesions.…”