1. Long-Term Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients Who Have Undergone Coronary Artery Bypass Grafting vs Those Who Have Not.
- Author
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Azzalini L, Ojeda S, Karatasakis A, Maeremans J, Tanabe M, La Manna A, Dautov R, Ybarra LF, Benincasa S, Bellini B, Candilio L, Demir OM, Hidalgo F, Karacsonyi J, Gravina G, Miccichè E, D'Agosta G, Venuti G, Tamburino C, Pan M, Carlino M, Dens J, Brilakis ES, Colombo A, and Rinfret S
- Subjects
- Age Factors, Aged, Chronic Disease, Cohort Studies, Coronary Angiography methods, Coronary Artery Bypass methods, Coronary Occlusion diagnostic imaging, Coronary Occlusion mortality, Female, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Percutaneous Coronary Intervention mortality, Prognosis, Proportional Hazards Models, Reference Values, Retreatment, Retrospective Studies, Risk Assessment, Severity of Illness Index, Sex Factors, Survival Analysis, Time, Treatment Outcome, Coronary Artery Bypass adverse effects, Coronary Occlusion therapy, Percutaneous Coronary Intervention methods, Registries
- Abstract
Background: We aimed to investigate the procedural and long-term outcomes of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in patients who had undergone previous coronary artery bypass grafting (CABG) vs those who had not, and to evaluate the role of the Registry of CrossBoss and Hybrid procedures in France, the Netherlands, Belgium, and United Kingdom (RECHARGE) score in predicting acute and long-term outcomes., Methods: We compiled a multicentre registry of consecutive patients undergoing CTO PCI at 7 centres between January 2009 and April 2017. The primary end point was target-vessel failure (TVF), a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization on follow-up., Results: Overall, 2058 patients were included (patients who underwent CABG, n = 401; CABG-naïve patients, n = 1657). Patients who had undergone CABG were older and had a higher prevalence of comorbidities and higher occlusion complexity (RECHARGE score, 3.6 ± 1.3 vs 1.8 ± 1.2; P < 0.001). Antegrade dissection/re-entry techniques and the retrograde approach were used more frequently in patients who had undergone CABG. Procedural metrics were worse, and technical (82% vs 88%; P = 0.001) and procedural (81% vs 87%; P = 0.001) success was lower in patients who had undergone CABG. They also experienced a higher rate of major complications (3.7% vs 1.5%; P = 0.004). The RECHARGE score was inversely associated with technical success (P < 0.001). Median follow-up was 377 days (interquartile range, 277-766 days). The 24-month TVF rate was higher in patients who had undergone CABG than in CABG-naïve patients (16.1% vs 9.0%; P < 0.001). On multivariable analysis, the RECHARGE score (hazard ratio, 1.61; P < 0.001) remained an independent predictor of TVF, together with longer total stent length and not using a drug-eluting stent., Conclusions: Compared with CABG-naïve patients, CTO PCI in patients who had undergone CABG shows higher procedural complexity, worse success rates, and higher adjusted risk of TVF on follow-up., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2018
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