Effect of Lesion Age on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary US Multicenter Registry

Abstract

Background We sought to determine the impact of lesion age on procedural techniques and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods We examined the characteristics and outcomes of 394 CTO PCIs with data on lesion age, performed between 2012–2016 at 11 experienced US centers. Results Mean patient age was 66 ± 10 years and 85.6% of patients were men. Overall technical and procedural success were 90.1% and 87.5%, respectively. A major adverse cardiovascular event (MACE) occurred in 16 patients (4.1%). Mean and median lesion ages were 43 ± 62 months and 12 months [interquartile range 3–64 months], respectively. Patients were stratified into tertiles by lesion age (3–5, 5–36.3, and >36.3 months). Older lesion age was associated with older patient age (68±8 vs. 65±10 vs. 64±11 years, p=0.009), prior coronary artery bypass grafting (62% vs. 42% vs. 30%, p<0.001) and moderate/severe calcification (75% vs. 53% vs. 59%, p=0.001). Older lesions more often required use of the retrograde approach and antegrade dissection/re-entry for successful lesion crossing. There was no difference in technical (87.8% vs. 89.6% vs. 93.0%, p=0.37) or procedural (86.3% vs. 87.4% vs 89.0%, p=0.80) success, or the incidence of MACE (3.1% vs. 3.0% vs. 6.3%, p=0.31) for older vs. younger occlusions. Conclusions Older CTO lesions exhibit angiographic complexity and more frequently necessitate the retrograde approach or antegrade dissection/reentry. Older CTOs can be recanalized with high technical and procedural success rates and acceptable MACE. Lesion age appears unlikely to be a significant determinant of CTO PCI success.

Differences in patients and lesion and procedure characteristics depending on the age of the coronary chronic total occlusion

“…In contrast to the study of Danek et al , we found that CTO length increased with age of the CTO [10]. In our study, even occlusion duration longer than 6 months was an independent predictor of CTO length over 20 mm.…”

“…As observed in previous studies, patients with longer CTO duration had longer procedure and fluoroscopy time, as well as a greater amount of dye used [10]. These results should be taken into account when planning a procedure with known age of the CTO.…”

“…Comparable to our results, Danek et al . recently observed a difference of 16% in moderate/severe calcification between patients with a CTO duration shorter than 5 and longer than 36.3 months [10]. Moreover, as previously reported, CABG in medical history was also associated with higher prevalence of calcification in CTO lesions [21].…”

“…However, as determining age of the CTO may be very challenging, most of them did not include this factor in the analysis. There are several reports describing how and whether CTO duration may affect lesion and procedural characteristics [10–14].…”

The value of fragmented QRS in predicting the prognosis of chronic total occlusion patients with myocardial infarction history undergoing percutaneous coronary intervention: A 24‐months follow‐up study

“…Many studies have shown that the CTO of the coronary artery is associated with cardiac dysfunction 10,11 . Some studies have found that the cardiac function and quality of life can be improved to a certain extent after opening occluded vessels in CTO patients 12‐14 . Many patients with a history of myocardial infarction (MI) underwent at least one coronary artery with CTO and experienced cardiac dysfunction due to failure to timely open the occluded artery 15 .…”