In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery

Abstract

Background: We examined the procedural outcomes of chronic total occlusions (CTO) percutaneous coronary interventions in patients with prior coronary artery bypass graft surgery (CABG). Methods and Results: We compared the clinical, angiographic characteristics and outcomes of 3486 CTO interventions performed in patients with (n=1101) and without (n=2317) prior CABG at 21 centers. Prior CABG patients (32% of total cohort) were older (67±9 versus 63±10 years; P <0.001) and had more comorbidities and lower left ventricular ejection fraction (50% [40–58] versus 55% [45–60]; P <0.001). The CTO target vessel in prior CABG patients was the right coronary artery (56%), circumflex (26%), and left anterior descending artery (17%). The mean J-CTO (2.9±1.2 versus 2.2±1.3; P <0.001) and PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; 1.5±1.1 versus 1.2±1.0; P <0.001) score was higher in prior CABG patients. Retrograde (53% versus 30%, P <0.001) and antegrade dissection reentry (35% versus 28%; P <0.001) techniques were used more frequently in prior CABG patients. Prior CABG patients had lower technical (84% versus 89%; P <0.001) and procedural (82% versus 87%, P <0.001) success, but similar incidence of in-hospital major complications (3.1% versus 2.5%; P =0.287). In-hospital mortality (1% versus 0.4%; P =0.016) and coronary perforation (7.1% versus 3.1%; P <0.001) occurred more frequently in prior CABG patients, however, CABG patients had a lower incidence of pericardial tamponade (0.1% versus 1.0%; P =0.002) and pericardiocentesis (0% versus 1.3%; P <0.001). Conclusions: In a large multicenter CTO percutaneous coronary interventions registry, prior CABG patients had lower success rate but similar overall risk for complications, although mortality was higher and the incidence of tamponade was lower. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02061436.

Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

“…Diabetes mellitus is associated with multi-, small vessel, diffuse atherosclerotic disease and higher rate of periprocedural MI, contrast induced nephropathy which may impact on procedure success rate and complications that consequently affect long term outcomes. However, in Bypass Angioplasty Revascularization Investigation 2 Diabetes trial, CTO didn't increase periprocedural mortality in diabetes patients treated either by PCI or bypass surgery but it was associated with poor prognosis if left untreated [31,32]. In our study, technical success rate of revascularization of CTO in diabetics was not different as compare to that of non-diabetics with similar peri-procedural complications.…”

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

“…Right coronary artery (RCA) CTO has been observed in approximately 38–50% [1, 5–7] of the entire CTO population. Although CTO revascularization was observed to have an acceptable success rate and to gain more clinical benefits from successful procedures [8, 9], the RCA-CTO patients who are treated with revascularization, either by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), are fewer than those patients with left anterior descending branch (LAD) CTO [1, 3, 4, 10]. We speculated that the reason for this discrepancy might partially because the territory of the RCA is smaller than that of the LAD and partially because the conflicting debates on the question of whether the successful reperfusion of RCA-CTO offers patients clinical benefits.…”

Chronic total occlusion recanalization for myocardial infarction

“…In our patient, PCI of the SVG would carry high risk for acute vessel occlusion which prompted recanalization of the native RCA CTO. However, CTOs in prior CABG patients can be challenging to treat as they often have blunt stump, severe tortuosity, and severe calcification, likely because the distal cap is exposed to systemic arterial pressure . As a result, CTO PCI is best performed as a planned procedure and not ad hoc, as was done in our case.…”