Effect of Previous Failure on Subsequent Procedural Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention (from a Contemporary Multicenter Registry)

Abstract

We sought to examine the impact of prior failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic characteristics and procedural outcomes of 1,213 consecutive patients who underwent 1,232 CTO PCIs between 2012 and 2015 at 12 US centers. Mean age was 65 ± 10 years and 84.8% of patients were men. A prior failed attempt had been performed in 215 (17.5%) patients. As compared with patients without prior CTO PCI failure, patients with prior failure had higher Japanese Chronic Total Occlusion (J-CTO) score (2.40 ± 1.13 vs. 3.28 ± 1.29, p<0.0001), and were more likely to have in-stent restenosis (10.5% vs. 28.4%, p<0.0001) and to undergo recanalization attempts using the retrograde approach (41% vs. 50%, p=0.011). Technical (90% vs. 88%, p=0.390) and procedural (89% vs. 86%, p=0.184) success were similar in the two study groups, however, median procedure time (125 vs. 142 min, p=0.026) and fluoroscopy time (45 vs. 55 min, p=0.015) were longer in the prior failure group. In conclusion, the main finding of our study is that a prior failed CTO PCI attempt is associated with higher angiographic complexity, longer procedural duration and fluoroscopy time, but not with the success and complication rates of subsequent CTO PCI attempts.

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

“…Known lesion age may be a proxy for more advanced cardiovascular disease and more experience with diagnostic procedures and treatment, including failed CTO PCI, which has been associated with higher lesion complexity. 24 …”

Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score

“…Variables strongly associated ( P ≤ 0.05) with technical failure were entered in a stepwise multivariate selection analysis. Certain non‐significant variables were included as well, based on their reported procedural impact , as they could contribute significantly to the final multivariate model (i.e., better fit of the model). The P value thresholds were set at 0.05 to identify independent predictors of technical failure.…”

Assessment of reattempted percutaneous coronary intervention strategy for chronic total occlusion after prior failed procedures: Analysis of the Japanese CTO‐PCI Expert Registry

“…The prior failure of CTO‐PCI is regarded as one of negative factors in the Japanese CTO (J‐CTO) score, which was developed to predict the likelihood of successful guidewire (GW) crossing within 30 min . CTO‐PCI after a previously failed procedure can be challenging to perform and has variable success rates . However, there have been no previous reports focusing on a strategy for reattempt CTO‐PCIs following previously failed procedures.…”