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Tajti P, Burke MN, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Mahmud E, Choi JW, Doing AH, Datilo P, Toma C, Smith AJC, Uretsky B, Holper E, Garcia S, Krestyaninov O, Khelimskii D, Koutouzis M, Tsiafoutis I, Moses JW, Lembo NJ, Parikh M, Kirtane AJ, Ali ZA, Doshi D, Jaber W, Samady H, Rangan BV, Xenogiannis I, Ungi I, Banerjee S, Brilakis ES. Prevalence and Outcomes of Percutaneous Coronary Interventions for Ostial Chronic Total Occlusions: Insights From a Multicenter Chronic Total Occlusion Registry. Can J Cardiol 2018; 34:1264-1274. [PMID: 30269827 DOI: 10.1016/j.cjca.2018.07.472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/06/2018] [Accepted: 07/19/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ostial chronic total occlusions (CTOs) can be challenging to recanalize. METHODS We sought to examine the prevalence, angiographic presentation, and procedural outcomes of ostial (side-branch ostial and aorto-ostial) CTOs among 1000 CTO percutaneous coronary interventions (PCIs) performed in 971 patients between 2015 and 2017 at 14 centres in the US, Europe, and Russia. RESULTS Ostial CTOs represented 16.9% of all CTO PCIs: 9.6% were aorto-ostial, and 7.3% were side-branch ostial occlusions. Compared with nonostial CTOs, ostial CTOs were longer (44 ± 33 vs 29 ± 19 mm, P < 0.001) and more likely to have proximal-cap ambiguity (55% vs 33%, P < 0.001), moderate/severe calcification (67% vs 45%, P < 0.001), a diffusely diseased distal vessel (41% vs 26%, P < 0.001), interventional collaterals (64% vs 53%, P = 0.012), and previous coronary artery bypass graft surgery (CABG) (51% vs 27%, P < 0.001). The retrograde approach was used more often in ostial CTOs (54% vs 29%, P < 0.001) and was more often the final successful crossing strategy (30% vs 18%, P = 0.003). Technical (81% vs 84%, P = 0.280), and procedural (77% vs 83%, P = 0.112) success rates and the incidence of in-hospital major complication were similar (4.8% vs 2.2%, P = 0.108), yet in-hospital mortality (3.0% vs 0.5%, P = 0.010) and stroke (1.2% vs 0.0%, P = 0.030) were higher in the ostial CTO PCI group. In multivariable analysis, ostial CTO location was not independently associated with higher risk for in-hospital major complications (adjusted odds ratio 1.27, 95% confidence intervals 0.37 to 4.51, P = 0.694). CONCLUSIONS Ostial CTOs can be recanalized with similar rates of success as nonostial CTOs but are more complex, more likely to require retrograde crossing and may be associated with numerically higher risk for major in-hospital complications.
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Affiliation(s)
- Peter Tajti
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; University of Szeged, Division of Invasive Cardiology, Department of Second Internal Medicine and Cardiology Center, Szeged, Hungary
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mitul Patel
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California, USA
| | - Ehtisham Mahmud
- VA San Diego Healthcare System and University of California San Diego, La Jolla, California, USA
| | - James W Choi
- Baylor Heart and Vascular Hospital, Dallas, Texas, USA
| | | | - Phil Datilo
- Medical Center of the Rockies, Loveland, Colorado, USA
| | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - A J Conrad Smith
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Barry Uretsky
- VA Central Arkansas Healthcare System, Little Rock, Arkansas, USA
| | | | - Santiago Garcia
- VA Minneapolis Healthcare System and University of Minnesota, Minneapolis, Minnesota, USA
| | - Oleg Krestyaninov
- Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Dimitrii Khelimskii
- Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Michalis Koutouzis
- Korgialeneio-Benakeio Hellenic Red Cross General Hospital of Athens, Athens, Greece
| | - Ioannis Tsiafoutis
- Korgialeneio-Benakeio Hellenic Red Cross General Hospital of Athens, Athens, Greece
| | | | | | | | | | - Ziad A Ali
- Columbia University, New York, New York, USA
| | | | - Wissam Jaber
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Habib Samady
- Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Bavana V Rangan
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Imre Ungi
- University of Szeged, Division of Invasive Cardiology, Department of Second Internal Medicine and Cardiology Center, Szeged, Hungary
| | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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