TCT CONNECT-236 Percutaneous Coronary Intervention of Chronic Total Occlusions Involving a Bifurcation: Insights From the PROGRESS-CTO Registry

Background: The impact of bifurcations at the proximal or distal cap on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We analyzed the clinical, angiographic, and procedural data of 6,066 cases performed for patients between 2012 and 2020 in a global CTO PCI registry. We compared 4 groups according to bifurcation location: “proximal and distal cap,” “proximal cap only,” “distal cap only,” and “no bifurcation.” Results: The CTO involved a bifurcation in 67% cases, as follows: proximal cap (n = 2,006, 33%), distal cap (n = 815, 13%), or both caps (n = 1,268, 21%). Proximal and distal cap patients were more likely to have had prior myocardial infarction (52% vs. 45% vs. 42% vs. 44%, p \u3c 0.001) or coronary artery bypass grafting (35% vs. 26% vs. 32% vs. 27%, p \u3c 0.0001) when compared with proximal cap only, distal cap only, and no bifurcation groups, respectively. Proximal and distal cap cases had higher Japan-CTO (2.9 ± 1.1 vs. 2.5 ± 1.2 vs. 2.4 ± 1.3 vs. 2 ± 1.3, respectively; p \u3c 0.0001) and greater use of the retrograde approach (47% vs. 40% vs. 30% vs. 20%, respectively; p \u3c 0.0001). Technical success was significantly lower in the proximal and distal cap group (79% vs. 85% vs 85% vs 90%, respectively; p \u3c0.0001), with major adverse cardiovascular event rates being similar (2.3% vs. 2.3% vs. 1.6% vs. 1.3%, respectively; p = 0.06). Compared with no bifurcation, the presence of any bifurcation was associated with higher Japan-CTO score (2.6 ± 1.2 vs. 2 ± 1.3; p \u3c 0.0001) and lower technical success (83% vs. 90%; p \u3c 0.0001). Conclusion: More than two-thirds of CTO PCIs involve a bifurcation, which is associated with lower technical success but similar risk for complications

Procedural and In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Patients With Acute Myocardial Infarction: Insights From a Prospective Multicenter International Registry

BACKGROUND: We sought to examine the procedural and clinical outcomes of patients who underwent chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in the setting of acute myocardial infarction (AMI). METHODS: We assessed the clinical and procedural characteristics, technical success, procedural success, and in-hospital outcomes of 2314 patients who underwent CTO-PCI at 20 experienced centers between 2012 and 2017, classified according to whether or not they presented with AMI. RESULTS: Mean patient age was 65 ± 10 years, 85% were men, and 154 (6.7%) presented with AMI (5.5% with non-ST segment elevation myocardial infarction, 1.1% with ST-segment elevation myocardial infarction). Compared with non-AMI patients who underwent CTO-PCI, AMI patients had higher prevalence of diabetes (56% vs 42%; P\u3c.01) and lower median left ventricular ejection fraction (48% vs 54%; P\u3c.001). The CTO angiographic characteristics were similar between the 2 groups. Compared with non-AMI patients undergoing CTO-PCI, AMI patients had more frequent use of antegrade wire escalation (86.0% vs 78.9%; P=.03) and more frequent use of hemodynamic support devices (16.2% vs 3.4%; P\u3c.01), and were more likely to have a non-CTO lesion treated (34.0% vs 26.6%; P=.03). AMI and non-AMI patients had similar technical success (90% vs 87%; P=.26), procedural success (88% vs 85%; P=.38), and incidence of in-hospital MACE (2.6% vs 2.5%; P=.94). CONCLUSION: CTO-PCI is performed infrequently in AMI patients and is associated with similar technical and procedural success rates and in-hospital major adverse cardiovascular event rates when compared with CTO-PCI performed in non-AMI patients

Single vs. multiple operators for chronic total occlusion percutaneous coronary interventions: From the PROGRESS-CTO Registry

BACKGROUND: There is limited data on the impact of a second attending operator on chronic total occlusion (CTO) percutaneous coronary intervention (PCI) outcomes. METHODS: We analyzed the association between multiple operators (MOs) (\u3e1 attending operator) and procedural outcomes of 9296 CTO PCIs performed between 2012 and 2021 at 37 centers. RESULTS: CTO PCI was performed by a single operator (SO) in 85% of the cases and by MOs in 15%. Mean patient age was 64.4 ± 10 years and 81% were men. SO cases were more complex with higher Japan-CTO (2.38 ± 1.29 vs. 2.28 ± 1.20, p = 0.005) and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention scores (1.13 ± 1.01 vs. 0.97 ± 0.93, p \u3c 0.001) compared with MO cases. Procedural time (131 [87, 181] vs. 112 [72, 167] min, p \u3c 0.001), fluoroscopy time (49 [31, 76] vs. 42 [25, 68] min, p \u3c 0.001), air kerma radiation dose (2.32 vs. 2.10, p \u3c 0.001), and contrast volume (230 vs. 210, p \u3c 0.001) were higher in MO cases. Cases performed by MOs and SO had similar technical (86% vs. 86%, p = 0.9) and procedural success rates (84% vs. 85%, p = 0.7), as well as major adverse complication event rates (MACE 2.17% vs. 2.42%, p = 0.6). On multivariable analyses, MOs were not associated with higher technical success or lower MACE rates. CONCLUSION: In a contemporary, multicenter registry, 15% of CTO PCI cases were performed by multiple operators. Despite being more complex, SO cases had lower procedural and fluoroscopy times, and similar technical and procedural success and risk of complications compared with MO cases

The Impact of Laser Use on the Outcomes of Balloon Uncrossable and Balloon Undilatable Chronic Total Occlusion Percutaneous Coronary Intervention

Background: We sought to examine the impact of laser use on the outcomes of balloon uncrossable and balloon undilatable chronic total occlusions (CTO) undergoing percutaneous coronary intervention (PCI). Methods: The baseline clinical and angiographic characteristics and procedural outcomes of 4,845 CTO PCIs performed between 2012 and 2020 at 32 international centers were examined. Results: Of the 4,845 CTOs 752 (15.5%), there were balloon uncrossable or balloon undilatable that were included in the further analyses. Mean patient age was 66.9 ± 10 years and 83% were men, with 51% prevalence of diabetes mellitus. Laser was used in 20.3% of the lesions. Compared with cases in which laser was not used, laser use was associated with longer occlusion length (33 [21, 50] vs. 25 [15, 40] mm, p = 0.0004) and in-stent restenotic lesions (41% vs. 20%, p \u3c 0.0001). Laser use was associated with higher technical (91.5% vs. 83.1%, p = 0.010) and procedural (88.9% vs. 81.6%, p = 0.033) success rates and similar incidence of major cardiac adverse events (3.92% vs. 3.51%, p = 0.805). Laser use was also associated with longer procedural (169 [109, 231] vs. 130 [87, 199], p \u3c 0.0001) and fluoroscopy time (64 [40, 94] vs. 50 [31, 81], p = 0.003). [Formula presented] Conclusion: In a contemporary, multicenter registry balloon uncrossable and balloon undilatable lesions represented 15.5% of the CTO PCIs. Laser was used in approximately one-fifth of these cases. Use of laser was associated with higher technical and procedural success and similar major complication rates. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP